·No text on this page.

·INTRODUCTION TO MALARIA PROBLEM IN INDIA

·No text on this page.

·INTRODUCTION
TO
MALARIA PROBLEM
IN INDIA
Dossabhoy Hormusjee Cama Prze Essay 1944
University of Bombay
Revised and brought uptodate
BY
Lieur COLOVEL B L RAINA
ARVY MEDICAL CORPS
With an Introduction b
DR JIVRAJ N MCHT
VD (London) VRCP (London)
NEW BOOK CO LTD
789-00 HORARY ROAD FORT
BOVRAY
1931

·By the same author
FAMILY PLANNING WHY WHEN & How
HEALTH & How To hEEP IT (WRAT To Eat & Wm)
All nghts reserved by the author
1951
Published by PF Dioshaw for New Book Co Ltd 188 190 Hornby
Road Fort Bombay and Printed by S N Guba Ray at Sree Saraywaty
Press Limited 32 Upper Circular Road Calcutta

·INTRODUCTIO V This brochure by Dr Raina which is an claboration of the thesis he submitted to the University of Bombay and for which he was awarded the Dossabhoy Cama prize by the Syndicate of the University is as the title indicates an Introduction to the Malaria Problemn in India The author deals with the problem in vanous aspects He explains it by saying that the heavy toll taken bv the discase whether of the envil population or of the Army * such as to make it imperatre for the authonties to be less apathetic and the people less ignorant about it The author has by facts and figures shown how greatly malaria contnbutes both directly and indirectly to the lugh morta lity as well as morbidity in this country He has also shown that morc soldiers have died of malana than by chemy action and yet the author points out that more is done to combat diseases lihe pingue cholcra ctc than to combat malaria This neglect on the part of authority as well as of the people is duc as stated by the author to the fact that the haioc cauyd by malaria is not so glaring hi perceptible as that cause ] by say plague or cholera He is therefore right in bringing the fact to the public notice that apart from the high mortalıts due to malaria It is a discase which along with hookworm so widely distributed in rural areas sap the vitality of the nation and is therefore a grenter enemy of the people and must not be neglected any longer The author gives 1 brief but interesting histor of the efforts made to find out the causes of malaria and also the various method of combating it He finally says Thc solution of the malaria problem in India requires serious consideration of five principal factors 172 (1) education (2) organization (3) inedical protection (1) legislation And (s) funds to one will dispute the fact that health education hould form part of general education of the chiki The 1191 terognition of this fact has made 11par hrault in

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·Plastnod um v vax Figs I 13 (Original) 1 2 Young trophozoite ring fortis 33 Growing treph forms Parasites show marked amubo d acti ity Corpuscl s are enlar1 pile and show chafner s dots Cranules of pigmentare sitr throughout the cytoplasm un figs 4 and 5 68 De elop ng uchuzyrt Mature wchzont The pigment has collected into a loose mas 1 formation of merozoites bas taken place 10 Mature mirog met cuir The chromatın 19 d ffuse an the cytoplas n stains pale blue col 11 Matre macrogametocyte The cytoplasm stains de p blue II chromat n is compact and stains deeply 12 ch zont ani gimt xy with n the same corpuscles 1) TWO schizonts w tl in the same corpu 1 Plasmod um falcipar m Figs 24 31 (Original) 14 long rang form 15 Toung ning form w th duubl cho at n 16 17 Vulcat de int ction of corpuscles alw howing marginal or ace It forms 18 "1 Tenue forms correspond og to Plas olm hteph ns 1914 22 23 Large ting forms 11 infected corpuscles Murer s dots 24 Crowing trophozoste form from a culture trhu lost th vacuole and a jet black com; et mass of Pament ha apparu 23 27 De elop ng schizonts tron Ciltu 28 29 Matu Kch ont froin culture 30 Mature 1 rogimetorite 31 Vat te mikrog1m toc, tc The pra a A PI mod um mal Hige 32-43 (Ong nal) 32 Young ring form 33 36 ( row ng tropho oit form showing charact rust c band forms 37 Larg mctangular bund form 38 39 Dr png sch ronts 40 41 Mature achizonts 42 Mat or Mic 01 to 4 Vature microgim tocyte Pia mod um ople Fug 4450 (After Jame 1930) 49 (CÓ tropho o tes 46 47 De tlop ng Khiront lore Khiront 19 crogam tacit 10 Vacropum tocyt

·MALARIA PARASITES OF MAN
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(From Knowles s Introduction to Medical Protozoolo
edited by B M Das Gupta 1944)
cou lesy 11 Ostetos Hool of r aprol Vedci
& Pn led by Siye Sant Pau Ltd Ca} tr
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·+ 1211 ***}ara (Peshawar District and Hot Mardan) t'onest type of feser CHAPTER I HISTORY Vuanial flver is not a new phenomenon in the medical any of India Some of the earlist references to this 7 Okcur in the Atharva Veda believed to have been mposed about 1500 BC It was classified even in Atharva according to the periodicity of attack of fever se Sanne (sadandım) tertian (Irstivakami) and quartan Jam It was also classified according to the season thich the fever made its appearance viz winter (silan) meteryn (graisman) and rainy season (varsikam) It was maumon especially where there was excessive aha vsak) or too much grass (műjavanta) It also leads the assumption that such fevers were common in Anga Putry about Bhagalpur) and Magadha (Bihar State) rakam vulptivant sadind mula saradame rumanam Lams rurami graysmam malaya td sukan AV V 11 13 As Asya mwavania oko wsya mahdvpsda stay tanlanamesi* &nan Lahoresu wyocerah AT V 225 From the numerous references to it and analysis of its characteristics it would appear that malaria was the com Ils association with sosquito may be curmisca by the description, which gue nearly all the faracteristics and habits of mo quitoes especially needle Like proboscis (koosilla) bloody mouth (ohtláss än) and the baby of visiting the dwellings after sunset (salak pan sants sāyam) There is also reference to the use of odour ons or fumigating medications used to destroy them In has sukta 22 reference is made to takman Caraka and Susruth use the word Jzara for feier in general u unues to be the group name of all discases with feser as the main and dominating agn These authors of the Ayur Indic period classifv fcicr into fisc types instead of four ol Veda continuou- (Smtath) Tcmittent ·2 INTRODUCTION TO MALARIA PROBLEV IN INDIA (Satatah) quotidian (Anyedyuskah) tertian (Trtiyakal) and quartan (Caturthakah) ya salah pannylyantı sagan gardabhanadinah Ausul: ye ca kuksilah kakublah karubhah srimalt tanosadhe svam gandhena tis cinan vinasaya AV VIII 6 YO ye kukundhah kukurabhan knittind sarı bibirati Anba sva pranriyanto vane je kunate gi osam fanilo 1 sayāna AV VIII 6 II ye suryani na titiksanta atapantanamtim divak 4 ayan bastvasino durgandhumlloj tusyan makkan nasay 7mnast AV VII 12 ye suryat parisarpasts snuseva svasutadadhim bajasca tesam pingaica hrdayédhinividhyatam AT VIII 6 24 Punah pancavidho dysto dosakalabalabalát santatah satato nyedyustylıyakacaturthakah Ca C 334 Anyedyuskah pratsdinam dinam hitva trf yakah Dinadvayam yo viframya pratyett sa caturthakah Ca C 367 Saptahan và dažāham ta dvadasahamathupo it Santalya yo visargs syut santalak sa rigadyate Ahorair setatako diam kalavanuvarlate Anvedyuskastvahoratradekakalam pravartate Tytryakastytiye knı caturthe ha catterthakah Su U 39 69 70 71 The similes given by these two authors to explain the advent and periodicity of this kind of fever are very signi ficant Caraha for instance compares the phenomena to the seed sown in the ground which takes one day to grow in case of quotidian two days in case of tertian and three days in case of quartan when they grow up they invade the whole body and not being counter acted by anti bodies (pratyanıka) they cause the fever When the force of these invading elements is exhausted they return to their origi nal habitat and again begin to grow up Susruta compares the advent of fever to the tide and ebb of the ocean Caraha s account of the bfe history of malanal parasite is of special interest Both the authors also state that this kind of fever is common in low land or land at the foot of the mountain Besides these indirect references to malaria we find in the Susruta Samhita a direct reference to five species of mosquitoes siz sea born globular in shape the huge type black in colour and the mountainous The bite of the mountainous species (Pārvalıya) is stated to bear the same characteristics as that of deadly insects (Pranahara ·HISTORY 3 hila Dainsana) Later references to malarial mosquitoes or malanal ferer in lāgabhaſa Jadhala and Bhāvamisra are simply repetitions of the statements made by these two authors Presumably the use of mosquito-nets (masaka hari) sas also pres alent in India as would be evident from Varco Polo s account as euly as the 13th A D Adhlete yatra Blumenta buat kala ka alatt AdMilete latha dadiwm dosah ale ca kopyals Se urdhih slaldlam ca o apya dusasiatiy ham Calw tak oh ca ku to praly Habal blyat Aytav & Hi qalabald te westha vyavasthurah vurdme Alle ita ayants nerami maux CaCl ) 65 to Jatha verigam. velat ha dayutud mahodadhen laha an tad tamokastal a dxtamil yata Dosaurpoday. tadvaded yela guaro sya vel Tegaka au pasamyela yanka mbush' s I thi Sa U 39 73 74 Valakad-samudrah panimandalo Aastimastah Anak Adrvar ya ih Macta daffasya (v a kad dan salopkalce on ot yaste ! Asah a si lyalah la ak Su K 8 30 It will be obvious therefore that malaria as a disease and its association with the mosquito was known as early as the Vedic period in ancient India The word for mos quito in the Alhan a Veda is makka which is the same as masaka in classical Sanshrit The derivatives of the word mosquito in different Indo-European languages point out that an insect of this kind can be traced back to great antiquity rcsers recurring periodically and cases with enlarged splecns were referred to by Hippocrates Empedocles as reported to hase freed Selinus from fever in 550 BC by draining the marshes Eggpuan Greek and Roman writers associated malana with marshes and bad air Varro 727 16 BC and Columella about 116 B C refer to minute animals and norious streams in marshes Cicero #Tote about a temple of fever Goddess in Palatine Godiry Creet Ay Laun -Meca dy Sapuit Masaka wongaito from the root mat (-to bum) All these derivatives point to commor orixta And this must be • vord in the lado Ectopees language who the Aran Lamilies and ant Dolgate ope to Go and the otbry to oth brine the future ep oledo-Laropaea lengo labo Cacient Greek Laua etc ·2 INTRODUCTION TO VALARIA PROBLEV IN INDIA (Satatah) quotidian (Anyedyuskah) tertian (Trtıyakal) and quartan (Caturthakah) ye salah panaylyant: sajam gardabhanadinah Ansula ye ca kuksila) kakubhak karubhah srimak tanosadhe tvam gandhena tisticiran uinasuya AV VIII 6 10 yo kukundhah Auskurabhak andard Sant obhrats Alida ila prantyanto tane se kunate hosana tanito ni ayatha IV II1 6 II yo suryani na titiksanta atapantamamum divalt arāyān bastivasino durgandkuullokulusyan makkin māsay kinası AV VIII 6 12 ya sury at pansarpantı snuseva fi asurudadhım bajasca tesim Pengasca hrdayédhinividhyalam A VIII 6 Punah pancavidho drsto dosakalabalabalat samtalah satato nyedyusifliyakacaturthakah Ca CH 3 34 Anyedyuskah pratidinam dinam hitva triyukah Dinadvayanı yo zifrar iya pratyeti sa cutsrthakah Ca Ci 367 Saptahar va dašāham ta dvadasahamathapi ia Santalya yo visargi syal santatah sa nigadyate Ahoruire satatako diaw kalavanuyartate Anyedyuskasttahoratradekakalam pravartal Tri yakastrtiye lins caturthe ani catarthakah Su U 39 69 071 The similes given by these two authors to explain the and periodicity of this kind of fever arc very signi Caraha for instance compares the phenomena to the seed sown in the ground which takes one day to grow in case of quotidian two days in case of tertian and three days in case of quartan when they grow up they invade the whole body and not being counter acted by anti bodies (pratyanıka) they cause the fever When the force of these invading elements is exhausted they return to their origi nal habitat and again begin to grow up Susruta compares the advent of fever to the tide and ebb of the ocean Caraka s account of the life history of malarial parasite is of special interest Both the authors also state that this kind of fever is common in low land or land at the foot of the mountain Besides these indirect references to malaria we find in the Susruta Samhita a direct reference to five species of mosquitoes siz sea born globular in shape the huge type blach in colour and the mountainous of the mountainous species (Pārvaliya) is stated to bear the same characteristics as that of deadly insects (Prānahara The bite ·HISTORY 3 hita Damsana) Later references to malarial mosquitoes or malarial fever in Vagabhala Bādhava and Bhavainista are simply repetitions of the statements made by these two authors Presumably the use of mosquito-nets (masaka hari) was also prevalent in India as would be cuidcnt from Varco Polo s account as early as the 13th AD AdA lote yaths bh min bujam Alle ra makato Adhikt iarna dhalum dosah dala kwPyatı Sa v dhe i balak dlam ta prapya dosasistiralam Cat Thakam ca ku te praty kabalahiyat htud vegam gatabelisk ste Fue stad. vyavasthuak 7' a VILOMA ste male ita ayanti na ana malda Ca Ci 3 68 69 o 5 arhd udgame vela nadagitud mahodaddad Ierald *w ladevambkastat a id famut ya! sateoday fadiadwal yela tvo sya ve 1 apadnaHalimyesa yatha mohak sigart I the Sa U 39 73 74 Valakah-sdmud ak nan mandalo kastımaskah Asmah Adrval ya tha na <a ta dasfasva tv a kind dustsafofhaka arver yasts lash to tharatstalyala Alunak Su Ka 8 36 It will be obvious thercfore that malaria as a disease and its association with the mosquito was known as early as the Vedic period in ancient India The word for mos quito in the Athana Veda is makka which is the same as mastka in classical Sanskrit The derivatives of the word mosquito in different Indo-European languages paint out that an insect of this kind can be traced back to grcat antiquity Fesers recurring periodically and cases with enlarged spleens were referred to by Hippocrates Empedocles is reported to havc freed Selinus from fever in 550 B C by draining the marshes Egyptian Greek and Roman writers associated malana with marshes and bad air Varro 127 16 BC and Columella about 216 B C refer to minute animals and norious streams in marshes Cicero wTote about a temple of fever Goddess in Palatine Godfry rrek dy Lau-Mode Ay Saskrit alius bonuito fross the root rat (-to bum) All these derivatives polat to common orgia and this must be A rond to the Indo-Europees Lagoa wha tha Aryan LmLins hart pont triptatet ode to Grece soul the other to ladus librite the sputter *p of fous Europos lagoar ist esikt, Greek Lado et $ ·6 INTRODUCTIOV TO MALARIA PROBLEV IN INDIA surgeon described the malaria parasite at Constantine is Algeria Italians considered them as degenerated red cells They considered that Bacillus inalarıae isolated from water and soil by Klebs and Crudeli in 1879 was the causatre organism By 1885 Laveran s theory was accepted la 1884 Gerhardt had produced an attach of malaria by inject ing blood of malaria patient Golgi and his collaborators Marchiafava and Celle in Italy reported different species o malaria parasites Romanowsky s chromatın staining method since 1891 further facilitated observations and re search Koch distinctly showed three species of malaria It remained for Major Ronald Ross of the Indian Medical Service and Grassi and his colleagues to explode once and for all the theory of malaria based on bad air and decomposing vegetation Ross when on short leave to Sigur Ghat in 1896 while investigating cases of malaria found that 80% of the labourers had enlarged spleens He had a severe attack of malana himself before he returned to his duties in the army On the constant persuasion of Sir Patrick Manson (who it may be stated formulated the hypothesis of mosquito transmission theory in 1894 and sti mulated the interest of Ross in the theory and showed him the malaria parasite for the first time in London Hospital) Ross continued his investigations On the 20th August 1897 in Secunderabad he made his epoch making discovery (demonstrating the malaria parasite in a mosquito that had fed on blood with malaria parasite) and completed on the gth July 1898 the life cycle of the malana parasite of avian malaria (Plasmodium praecox) in mosquitoes Grassa Bignami and Bastianelli worked out the complete develop ment for human malaria in Anopheles maculipennis and transmitted the disease to man by the bite of the infected mosquito Two years after Sambon Low and Terzı lived in a mosquito proof house in Ostia an intensely malarious locality in Roman Campagna and remained free from malaria Mosquitoes fed on malaria patients were sent from Rome to London and were made to bite other patients Dr P Manson and Mr George Warren volunteered and both of them developed severe attacks of malaria leaving no tloubt that malaria is caused by a parasite harboured in ܚ ·HISTORI 7 the blood of human beings and is carried from man to man by the female mosquito of a certain species Full advan tage of these discos cries was not taken for long despite the heavy toll taken by malana In the world about 300 000 000 people suffer from malania In India out of the total deaths in 1931 60% were due to fever (! at least being due to malaria) and only 5% were due to the much dreaded group of discases like plagur and cholera Statistics covering the period 1932 to 1947 reucal that the malaria death rate approximates 37% of thc total number of deaths in India The incidence of malaria is of a still greater importance in war as it often incapacitates more troops than battle casualties Many military operations have been brought to a standsull by malana Cosell (1943) obsen ed that the very nature of an army s normal activities is such that almost every action it performs in a malarious country is calculated to promote the spread of the disease siz the constant movements of troops by night and day the (mployment of large numbers of men on night duties the dificulues of enforcing measures of personal protection the aggregation of large bodies of labourers the consequent introduction of new strains of malaria imong the troops the camping of troops in close proximity to malarious villages for strategic reasons the dispersion of troops over large areas instead of concentraung them in easılı protected camps diMculties of trinsport shortage of anti malana equipment and drug and the impossibility of ensuring that drugs are actually taken in the dosage and manner prescribed During the Walcheren expedition of 1809 out of 40000 4000 died from feter as against 6ás killed in action During the Ringoon expedition of 1804 05 there were only 35 deaths from wound, but 450 out of every 1000 men engaged died of malını In the Burma expedition of 18- the enterprise in Arahan had to be abandoned owing to fesor for escryone who was not dead was in hospital 65. of the whole fotre in action) In 1916 19 malana cut into its olin In Macedoni: over 170 000 British troops were admitted to liopital (anuan to Vay into ·8 INTRODUCTION TO MALARIA PROBLEM IN INDIA 150 cases June to December 1916 30 000 cases 1917 70 000 cases 1918 over 60 000 cases, 25 000 resistant cases re patriated and two million days were lost) In East Africa there were 107 702 admissions giving the highest rate per thousand Napoleon in 1809 is reported to have written to one of his ministers We rejoice to see that the English themselves are in the morasses of Zeeland only keep them in check and the bad air and fevers peculiar to the country will soon destroy them In 1942 in Assam and Arakan (before anti malaria measures were brought into full force) history once again repeated itself In April 1942 a large railway project was rendered ineffective as 90% of the labourers were down with malaria In the same year a quarter of the force in the Assam front became casualties from a small winged enemy-Anopheles mini mies In 1943 ratio of casualties from wounds to sickness was I 121 The total casualty rate per 1000 strength of Indian other ranks was 1128 9 1e statistically every soldier was more than once in hospital Half the sick suffering from all diseases were suffering from malaria In three months October to December 1942 18 000 cases mostly malaria were evacuated by the Eastern Army Field Marshal Lord Wavell instructed the G OCs in C that In theatres where future operations are likely to take place we may well find that disease and especially malana is a more dangerous factor than enemy resistance We have already had experience of the effects of a bad malarial season in Assam We must prepare to meet malaria by training as strict and as earnest as against enemy troops We must be as practised in the use of our weapons against it we are with the rifle we must study the habits of the mos quitoes as we do the tactics of the Japanese We must know methods of anti mosquito work as well as how to con struct trenches to hold a position Soon after malaria control measures were taken the malaria rate rapidly dropped In 1945 malaria incidence was reduced to one tenth of what it was in 1943 Over the whole Allied Land Forces South East Asia the malana sich rate dropped from 3 65 per 100g to o 20 per 1000 It can be confidently said that successful war against malana as ·HISTORY 9 as the major factor in the success of the Allies against the apanese Effects of malaria in peace ume are not so dramatic as diseases lihe plague or cholera Malaria imperceptibly Bps the vitality diminishes the normal expectation of hſe those that survie dislocates labour and industry and tards the economic and social progress of the country as whole It has been responsible for accelerating the physi al and intellectual degeneration of the people in tropics for enturies The live birth rate begins to fall after the malaria scason cts in and the reduction is most pronounced about a nonth after the epidemic us at its height Watson (1924) ointed out that when women get into a malarious localı y they rarely become pregnant and when pregnant soon bort Brahmachan (1923) observed in a sciere malaria pidemic that apart from a rue in malaria mortality of 00 the recorded non malaria death rate rises 2 times Jalana affects children and particularly those who are still n their teens destroys their blood cells and renders them inacmic and stunted both physically and mentally There can be no gainsaying that the malaria is one of the greatest problems which faces India It not only has a bancful influence on the growth of the population but by lowering their vitalty renders them more liable to contract other infections It has been esta mated that at least two million persons die in India every cur due to the direct and indirect effects of malaria and at least 725 to 175 million suffer from it resulting in great loss of life widespread misery and in money unbelievable millions of pound sterling annually (Sinton 1939) Malina tahes its toll in some places all the year round and in others seasonally and periodically The Northern and Western parts of the Indo-Pakistan sub-continent show marked seasonal incidence Christophers reported that during the 1908 epidemic many villages and even whole Thanas showed high inortality during Otober and nosem ber--in some instances as high as 300 400 and even 500 per mille Dunng years of abnormal epidemics total num bers of deaths may increase by to million The tele ·CHAPTER II THE PARASITE are There are three main species of malaria parasites the parasites protozoa class Sporozoa sub-order Haemosporidia genus Plasmodiun-Plasmodium vivax (Grassi and Feletti 1890) causing benign tertian malaria P malanae (Laveran 1881) quartan malaria and Pfalciparum (Welch 1897) malignant tertian malaria There is a fourth plasmodium called P ovale (Stephens 1922) * It is rare and almost limited to Africa and causes mild tertian fever Each of these has asexual cycle (schizogony) in man and sexual cycle (sporogony) in the female anopheline mosquito The different types of plas modia differ in morphology but their life history is essen tially the same The parasite in man undergoes a series of changes It is seen like a pale disc on or within a red blood cell with black or reddish blach particles scattered in the cytoplasm Particles collect in the centre round which the cytoplasm arranges itself into segments Finally the red blood cells break down Iberating the segments. called merozoites These merozoites adhere to other red cells enter them and grow at the expense of the haemoglobin and repeat the same cycle After several generations of merozoites a few develop into sexual forms (male or macro and female or micro gametocytes) The sexual forms cannot develop any further in the human body When taken by a specific mosquito macro and microgame tocytes join (syngamy) and form a zygote The zygote bores its way through the epithelium of the stomach of the mosquito encysts between the epithelium and the limiting membrane and becomes an oocyst in which numerous slender motile spindle shaped bodies about 12 154 called the sporozoites are formed The oộcyst ruptures when liberating the sporozoites into the caelomic cavity These sporozoites are motile and get collected in the salivary P tenue (Stephens 1914) is of a doubtfol species Man has also been experimentally infected with P knowless a parasite of monkeys ·THE PARASITE 13 1 glands of the mosquito and are injected with the salivary secretion into the human body when the mosquito next feeds The history of human malaria parasite after being injected into man by the mosquito till it appears in the air culating red blood cells remained a mystery till recently Shortt el al (1948a) reported the pre-erythrocytic forms of P cynomolg: (a malaria parasite of the monkeys) in liver on the sixth and seventh days of incubation period It was assumed that the life of P Livax in man would resemble that of P cynomolgı as seen in the liver of Blacaca nulata The above presumption was finally proved at Horton hospital Ayirabury where a large number of A maculipennis alroparuus infected with P ular were fed upon a patient and isolated salıvary glands of the infected mosquitoes were inoculated intrarcnously into the samc patient The biopsy was performed sei eral days after The material examined showed plasmodial masses studded with chroma tin particles very similar in appearance to those previously scen in the case of infection of the money with P C390 molgs The forms seen measured up to 42 H in diameter and showed in some instances the vacuoles noted in the case of P cynomolg: (Shortt et al 1918b) Thus the asexual and sexual forms of the malaria para site de clop in man and mosquito respectively The infected red cells in man rupture and relcase the merozoites to iniect fresh cells This coincides with the risc of tem perature and shivering The attack of fes cr mat occur in one type (quartan) csery 72 hours or every 4th day in the other two types (benign and malignant tertian) every 48 hours or every third day and in still other types daily or atiregular infers als (mixed infection) A person gets feser after not less than 10 to 14 days of the bite of the mosquito About 10 days after the attack of feser the sexual forms maturc in min If the mosquito of the carrier species feeds on an infected min having these sexual forms it takes the parisite about two weeks to desclop into the sporozoite provided climatic conditions are suitable for maturation of the malana parasite in the mosquito and the blood feed has been taken from a person carrying the sexual forms which are fully mature ·CHAPTER II THE PARASITE are There are three main species of malaria parasites-the parasites protozoa class Sporozoa sub-order Haemosporidia genus Plasmodium--Plasinodium vivax (Grassi and Feletti 1890) causing benign tertan malaria P malanae (Laveran 1881) quartan malaria and Pfalciparun (Welch 1897) malignant tertian malaria There is a fourth plasmodium called P ovale (Stephens 1922) * It is rare and almost limited to Africa and causes mild tertian fever Each of these has asexual cycle (schizogony) in man and sexual cycle (sporogony) in the female anopheline mosquito The different types of plas. modia differ in morphology but their life history is essen tially the same The parasite in man undergoes a series of changes It is seen like a pale disc on or within a red blood cell with black or reddish black particles scattered in the cytoplasm Particles collect in the centre round which the cytoplasm arranges itself into segments Finally the red blood cells break down liberating the segments called merozoites These merozoites adhere to other red cells enter them and grow at the cxpense of the haemoglobin and repeat the same cycle After several generations of merozoites a few develop into sexual forms (male or macro and female or micro gametocytes) The sexual forms cannot develop any further in the human body When taken by a specific mosquito macro and microgame tocytes join (syngamy) and form a zygote The zygote bores its way through the epithelium of the stomach of the mosquito encysts between the epithelium and the limiting membrane and becomes an oocyst in which numerous slender motile spindle shaped bodies about 12 15x called the sporozoites are formed The oocyst ruptures when liberating the sporozoites into the caelomic cavity These sporozoites are motile and get collected in the salivary P tenue (Stepbens 1914) 15 of a doubtful species Man has also bern expenmentally infected with P knowlest a parasite of monkeys ·THE PARASITE 13 glands of the mosquito and are cojected with the salivary secretion into the human body when the mosquito next feeds The Instory of human malaria parasite after being injected into man by the mosquito till it appears in the cir culating red blood cells remained a mystery till recently Shortt et al (1948a) reported the pre-erythrocytic forms of P Gyromolgi (a malaria parasite of the monkeys) in liver on the sixth and seventh days of incubation period It was assured that the life of P Livar in man would resemble that of P cynomolge as seen in the liver of Macaca mulata The above presumption was finally proved at Horton hos pital Ay Irabury where a large number of A maculipennis atroparuus infected with P viar were fed upon a patient and isolated salvary glands of the infected mosquitoes were moculated intravenously into the same patient The bropsy was performed several days after The material examined shoxed plasmodial masses studded with chroma tin particles very similar in appearance to those previously seen in the case of infection of the monkey with P Cyno molg: The forms seen measured up to 42 H in diameter and showed in some instances the vacuoles noted in the case of P cynomoig (Shortt et al 19.485) Thus the aserual and sexual forms of the malana para site develop in man and mosquto respectively The in fected red cells in man rupture and release the merozoites to infect fresh cells This coincides with the rise of texts perature and shivering the attack of fever may occur 1a one type (quartan) excry 72 hours or every 4th day in the other two types (berugn and malignant tertian) every 48 hours of every third day and in still other types daily or at inxegular intervals (mixed infection) A person gets fever after not less than ro to 14 days of the bite of the mosquito About to days after the attack of fever the sexual forms mature in man If the mosquito of the carner species feeds on an infected man having these sexual forms it takes the parasite about two weeks to develop into the sporozoite provided climatic conditions are smtable for maturation of the malana parasite is the mosquito and the blood feed bas been taken from a person carrying the sexual forms which are fully mature ·14 INTRODUCTION TO MALARIA PROBLEM IN INDIA The infected cell becomes enlarged in size in Privax infection The infected erythrocytes of P falciparum clump together and adhere to the walls of the capillaries leading to serious complications associated with malignant subtertian infection Another notable feature of P falat parum infection is that the cells may be infected with three or more sets of parasites concurrently each causing a conti nuous paroxysm of fever The incubation period differs in the different species about a week to 12 days in malignant tertian about two weeks in benign tertian and about three weeks in quartan infection Benign tertian infection is usually of a persistent type though it may have a low parasite count Symptoms are usually mild despite chill and high fever and paroxysms last for abo ten hours P vivax like P falciparum can sometimes give rise to severe cerebral symptoms (Dhaya gude and Purandare 1943) Joint pains herpes labialis and gastro intestinal symptoms especially vomiting are often noted Malana cases with symptoms of acute intesti 78] obstruction have been described Relapses after as many as ro to 20 years have been recorded fever are seen in both benign tertian and quartan Nephritis has been occasionally found Hyperpyrexia is seen espe cially with P falciparum infection and is a dangerous symptom Paroxysms of fever may last twenty to thirty hours and may show a double peak and no chill Mild febrile attacks of long duration anaemia black water fever together with pneumonic cardiac psychotic and algıd types, are not uncommon in the tropics The parasites show regional distribution and seasonal preference One species may be prevalent in one season and another at a different period due to variations of tem perature and humidity at different times If meteorological conditions remain uniform no change may be observed P vivax seems to predominate from March to July and P falciparum from July to December reaching maximum incidence in May and October respectively In areas where only one species of parasite is predo minant infection with the predominant species is found Rigors with ·THE PARASITE 15 and in those areas where two or three parasites are found a person can be infected with one or more of them Difier ent seasonal changes too may affect prevalence of mixed infection Gatdetocytes also show variations It is stated that relative output is lowest in P falciparum on the other hand its increased rate of shizogony ensures that its abso lute output of gametocytes is higher than in either of the other to species Knowles et al suggest that the propor tion of gametocytes may depend on long duration of infection age of patient (basal metabolism} administration of drugs and the season of the year when examination is made Mixed unfections constitute about 37% of the general malana of the world and may be distributed as follows P vivax plus P malanae 91% P vivax plus P falcı parum 79% P malansae plus p falciparum 10 4% P livax plus P malande plus P faloparum 1 5% Knowles et al (1930) give the following distribution Provinces Pvwar P molanas Alused falet parim No No somynsd possono org/ SO 1064 10 I 2 17 Ono 2707 1 694 88:4 2370 1330 900 10019 39 11 8/ 263 30 2 70 3813 2 209 1830 995 Goa WWFP 378 Punjab 364 Delhi 5446 Rajputana including Nepal 700 590 Bombay including 5540 Alysore State 694 Ilyderabad 356 COOTR 28 0 Madras Presy 5789 Agenty Tracts 410 Bihar Oriya 494 Bengal Presy 363 98 9 36 t6 373 1900 7437 $59 Descan 174 70 4 596 15199 975 723 &$10 3068 a t 473 205 $g 860 74 Over 7 814 1239 99 This aves an averall duttribution at fauon Putust Pmalanan Pfalat parem 75! 60 459 ·16 INTRODUCTION TO MALARIA PROBLEM IN INDIA The average gametocyte output of the three species (Calcutta findings) is, for p vivax 21 2% p malanae 44 7% P falciparum 18 9% Great vanations are found especially in the case of P falciparun (Knowles et al) It may be added that the distribution of the various species is not clearly understood Distribution of P malariae in general seems to be limited by summer isotherm of 60'F , P falciparum by 70°F P malariae appears to be a dying species maximum output of P falciparuin occurs often towards the close of transmission period Deaderick reported the following percentages of relapses Puivax 65% Pialariae Pfalciparum It will be seen that all plasmodia can cause further acute attacks of malana P vivax relapses are extremely com mon and the relapse rate is probably higher than quoted above The study of therapeutically induced malaria shows that benign tertian relapses occur first within three months of the primary attack and the second between the sixth and the ninth month of the first attack and the malig nant tertian relapses within three months of the first attack It may be added that lower bodily resistance from disease or malnutrition chill over exertion and fatigue also tend to precipitate relapses 55% 45% REFERENCES DHAYAGUDE RG AND PURANDARE NM (1993) Arch Patho logy 36 550-58 KNOWLES R SENIOR WHITE RAND DAS GUPTA BM (1930) Ind ) Med Res Mem 18 43 101 298 306 SHORTT HE GARNTIAM PC CAND MALANOS B (19.48a) Bnt Ved) jan 31 192 SHORIT HE GARNHAY PCC COVELL G AND SHUTE PG (1948b) Ibid March 20, 547 ·Drael s toager slendr CHAPTER W THE MOSQUITO There are approximately 1700 species of mosquitoes in the world but of these only about 180 are anophelines and out of these about 17 only are important carriers of malaria * Forty three species and g variants of anopheline mosquitoes have been identified in India and Pakistan out of which about 7 are chief vectors of this disease and a few others are of lesser importance In their hfe cycle all mosquitoes pass through four stages of development The fertilized eggs are lasd by the adult female mosquito on water Anopheline eggs are boat shaped and are laid singly and have distinctive markings They develop into larvae which he parallel to the surface of the water and feed on aquatic vegetation dead or kving and on animal hfe The laræ moult four times in tao days to several months and after their fourth moult develop into cornma shaped pupæ For a few hours to as many as a few days the pupa rests on the surface of water the skin then splits and the adult mosquito emergest • About 60 species of Asapheles bave been incremated in the world 12 CBTT: but there may be others tot yet reported 1 The troph lines and Gula *t eget larve page and #dults can be disciaguiled from the following characteristics Anophel as Cuincena Eggs Boat abaped Dorsolateral { cropilat зрослая Ртрfonts TILS ergely cess at bead cod Tadially arranged Collect Inta clutops g ring tran Collect a raits of hungular and star shapes dreds of eggs Lare Apertare op dia abta Long or short wypbon Digal pegment tube os 8th #bxdommat Float parallel to the Float bead downt with e face of water to be on surface Spracttbort stampy add fatpel shaped and trumpet kaped Long and clab_thaped Long tod pening palpl marge toes Talpi 13 Bp bed like proboscis in shorter than proboacia la fernate Woen Isting feruate Proboscis beat ut appear to tapu on its apgle with body Rest head except a few specles parallel to the su lace OT Kement in male pomene to make as ·20 INTRODUCTION TO MALARIA PROBLEM IN INDIA are laid and where the larvæ breed the water is usually still Ovipositing females avoid flowing water even when the velocity is as low as one foot in 20 seconds Larvæ are unable to resist a current velocity greater than o 29 foot per second The larvæ are also strongly attracted to shade This attraction is so great that the larvæ will leave unshaded zones of still water in favour of shaded zones where the cur rent may be sufficient to flush them downstream The thermal death point of the larvæ is 41 F The maximum water temperature of typical A minimus running water breeding places seldom exceeds 35 C It is very sensitive to pollution by decomposing vegetation and this sensitivity may be one of the deciding factors for the gravid female to avoid oviposition in polluted water collections The relation of ferruginous water to breeding places seems to depend on lack of food (algæ) for the larvæ and not to any larvıcıdal action of colloidal iron Silt by itself has no marked lethal action on A minimus larvæ . The controlling effect attri buted to silt is due to increase in current velocity A mint mus lays more eggs in the monsoon but their expectation of life is greater at the end of the rainy season In the hot damp monsoon A minimus takes two days to digest a blood meal and develop its ovaries ovipositing occurs in the second night after feeding In cold weather this period is increased to 4-6 days In the dry zones of the Dooars the most important breeding places during cold weather are perennial seepages and small streams It feeds mostly on human beings Dark houses are preferred as resting places and 90 per cent of feeding takes place after midnight Natural infections are high during the months of March June August and September A philippinensis Ludlow 1902 This species is found in Assam East and West Bengal Bihar Bombay Deccan Chhota Nagpur Konkan Madras Coast North Malabar Mysore and Orissa It is an important vector in the plains of Bengal where it breeds in clear cool water with aquatic vegetation (especia" Hydnlla y Ceratophyllum demersum and Na filamentous green algae expo C water hyacinth blue green and ·THE MOSQUITO 21 alga of family Cynophyceae especially Microcystes aruginosa are inhubitory to breeding of the larva Subsoit water seems to bear myerse relation to the density of the breeding the lower the subsod water level the hugher is the density of this species In East and West Bengal the adult mosquito is found mainly in human habitations (Knshnan 1940 Iyengar 1994) In Assam however it is zoophilic and is normally found in cattle sheds (Ramsay 1944) The Usual resting places in the houses are on the wall within a few feet of the foor They bite usually from 8 PM to 10 PN and 2 AM to 4 AM A stephensı Liston 1901 Thus species is a vector in Western North western Peninsula and Northern parts of Indo-Pakistan sub-continent Bombay City Bangalore parts of Uttar Pradesh Tanna Tracts of Chinwan District Bhaust Tract of Amraou District and Rupzar Tract of Bala ghat It breeds in wells tons roof gutters tanks tubs seepages swamps marshes and strigation channels It can broed in water contaminated with sewage (Roy 1931) It has been reported breeding in salt pans during September and October in Bombay (Bana) 1943) Adults are strong fuers and may fly up to about 3 miles A stepkens var mysorensis Sweet and Rao 1937 It is found in Poona Sind Vizagapatam Mysore State and usually breeds in irrigation channels margins of streams and wells It is the chief rural carrer of malaria in Vizagapatam (Senior White 1943) A sundacus Rodenwaldt 1926 It is found on the Arakan coast in Sunderbans in Hoogly Estuary Coastal Best of Orissa Coastal Regions of Burma lower Bengal Madras State in salt lakes of Calcutta and Vizagapatam It breeds in brachish water partially cleared mangrove swamps artificial basins in which tidal water and fresh water mix and is often associated with rigue (Enteromot pha Cladophora Cyanophycer) Oscillatona germinala Lyngbya conferuordes Oedogoniums and dead aquatic vagctation (Potamogeton pechinatus Halophila ol als bound by alga Lyngby a aestuiani) Thes bite both in the day and night feed on human beings anel can fy for Olet a mile for their food ·22 INTRODUCTION TO MALARIA PROBLEM IN INDIA CARRIERS OF LOCAL IMPORTANCE A annularis Van der Wulp 1884 It is a carrier in parts of Bengal and Orissa Coastal Plain (Senior White and Rao I943) It has once been reported infected in nature at Ferozepur (Adie 1903) It breeds in still stagnant waters and pools tanks burrow pits and is often found associated with floating vegetation (Hydrilla verticillata Cerato phyllum demersum) and algal growth (Spirogyra) Even slow movement of water is not favoured by its larva The adults are found in houses in maximum numbers during August or September and in cowsheds during October and November During September October and the first half of November the adults appear to live longer and feed on human beings in preference to cattle A Jeyporiensis var candidiensts Koidzumi 1923 This species is found in Assam Bengal, Uttar Pradesh and Malabar Iyengar (1934) reported 4 gut infections out of 3833 dissected in Travancore It has been reported infected in nature in extreme South East Bengal (Arakan) It breeds in slow running streams and rivers with grassy edge> also in lakes swamps seepages and ditches A leucosphyrus Donitz 1901 It is found in Assam Bengal Konkan Madras Malabar and Mysore State It is reported to be a carrier in Digboi Assam (Clark and Chau dhury 1971) It usually breeds in partially shaded slow running grassy edged streams It feeds freely on human beings in Assam 75% out of 102 examined were found with human blood (Ramsay et al 1936) A maculatus Theobald 1901 This species is widely distributed in the submontane tracts in the North South and East of Indo-Pakistan sub-continent and of the Himalayas up to 8 000 feet It breeds 1 pools and river beds in sunshine and cattle It bites human beings after which it leaves the houses au banks (Venhuis 1941) and is of r A superpictus Grassi 1899 Baluchistan Wazıristan and the found east of the river Indus T ·THE MOSQUITO 23 and springs are seepages nyers streams irigation channels reservoirs It appears to have marked preference for running water exposed to sunlight especially along the edges of streams and masses of spirogyra The adult mosquito rests outdoors in cares karezes A taruna Iyengar 1924 It is found in Assam Bengal, Bihar, Bombay Chhota Nagpur Gujerat Konban, Madras East Coast Malabar Mysore Orissa and Uttar Pradesh It has been found infected in nature in Travancore Matheu 1939) Hooghly Delta (Iyengar 1928) Calcutta (Roy 1939) Jeypore Singhbhum Hulls and appears to be of no importance elsewhere It seems that there are two different biological races one in eastern coast of India and the other in the huis of Central India and Bengal Delta It breeds in terraced nice fields irrigation channels streams seepages and roadside storm water drains Adults are found in cowsheds and human habitations CARRIERS OF LITILE OR NO IMPORTANCE A acontus Donitz 1902 This is found in Assam Bengal Bihar Madhya Pradesh Hyderabad honhan, Madras North Coast Malabar Orissa and Uttar Pradesh Two specimens were reported infected (I gut I gut and gland) out of 24 dissected at Chandpur Bengal (Das 1943) One gut infection was reported from Jeypore Hills out of 107 dissected (Senior White 1937) and one gut infection out of 7x45 dissected from Lakhimpur Goalpara District It breeds 22 shamps ponds migadon channels nice fields roadside drains and tanks with grassy margins Adults are found in houses and cowshed A jcydoniensis James Igoz This is found in Assam Bengal Bombay Deccan Ceatral India Madhya Pradesh Uttar Pradesh Chhota Nagpur Gujerat Hyderabad State, honkan ladras State Alalabar and Mysore State Two get infections out of 674 dissected in Mysore State were found (Nursing Rao and Suect 1931) Senior White (1937) reported four gut infections out of 318 dissected in Jeypore Ha Tract Ramsay et al (1936) recorded one gut infection out of 3115 dissected it breeds a streams 3 ·24 INTRODUCTION TO MALARIA PROBLEM IN INDIA ingation channels, edges of ponds and lakes Adults are mostly found in cattle sheds A karwari James 1903 This species is found in Assam Bengal Bihar Bombay Deccan Chhota Nagpur Konkan Malabar Mysore State and Orissa One gut in fection out of 125 specimens dissected in Assam (Strickland 1929) and no infection in 15000 dissected (Ramsay et al 1936) have been reported It breeds in springs pools cool stream, swamps and seepages Adults are found both in cattle sheds and human habitation but mainly feed on cattle A kochs Donitz 1901 Ramsay (1930) reported only two gut infections out of 77 dissected in July at Cachar Assam (total dissected in the year 2113) It breeds in small pools irigation channels streams containers and split bamboos It feeds both on men and animals A palhdus Theobald 1901 This has been reported infected in nature from Chanda Madhya Pradesh (Kenrich 1914) Krishnagar Bengal (24 per cent gut infection Sur and Sur, 1929) Birnagar Bengal (Bose 1931) Birbhum Bengal (o 03% sporozoite rate Timbres 1935) Udaipur State (o 7 per cent gland infection Roy and Biswas 1942) Senior White and Adhikari 1970 reported only four infected out of 3157 dissected in the East Satpura Ranges It breeds in borrow pits rice fields and tanks Adults are mostly found in cattle sheds A pulchernmus Theobald 1902 It breeds in swamps pools and collections of stagnant water Adults are frequent in both cattle sheds and human habitation It is a strong Aler A ramsayı Covell 1927 Only one gland infection was reported out of 287 dissected in Assam by Ramsay in 1930 No further infection has been reported (Ramsay 1943) It is found in Assam Bengal Bihar and Orissa and breeds in tanks pools and swamps with vegetation especial ly Pistia stratiotes Adult mosquitoes rest in both cow sheds and human habitation A splendidus Koidzumi 1920 It has been reported infected in nature from Saharanpur (Robertson 1910) and Karnal (placdonald and Majd 1931) It breeds in small ·THE VOSQUITO poo's seepages tanks and streams with alge Adults a lound in catie sheds and houses A subpictus Grasst 1899 It has been reported infer ed in nature at Pattukottas Madras State (I gut and Ig and gland ont of 13277 dissected Russell and Rao 1941 Two gut infechons were also found positive in Ennore o of 4728 dissected (Russell and Jacob 1939) It breeds collectons of water borros pits roof gutters container sewage polluted pools and esen in brachish water Adu mostly feed on cattle and are found both in houses ar cattle sheds A vagus Donitz 1902 It is found in Assam Benga Buhar Bombay Deccan Madhya Pradesh Chhota Nagpu Gujerat Hyderabad Konkan Madras East and West Coa: Malabar Mysore State and Orissa It has been report infected in nature from Pattuhkotta S India (one glar infection out of 6874 dissected Russell and Rao loc cit) ai from Assam (2 gland infections out of 10452 dsssecte Strickland et al 1933) It breeds in small pools and found in houses and cattle sheds but feeds mostly! amals way de th 1 Barma var Balaya Indu dat tatural infectios 18 them have not yet been reported w TS following additional spects of coophelia have been reported Aiken A a tkant var bengalen 1 annandal 4 aananda var interruptus doo osins A da birostris var am A Banax S A d vice var habıdı A Culciformu A dtwall 4 gigas 4 64 var belayu 48 845 vas refulans sugas vas simplensts Ayrcus hyr axus var #igermus Asulaflorum Araness A Indesa *7 desayi var nul genicus thoghalensts color PA SCOUTERSIS Å se gent A sinton A s natus Aih bol #txe khud and Ambroses To following are known vectory in the peagabrosting countries A MINS A yponent $ condid en Und c* A Annulans A sunda s & marwiatus Amb OSMI 1982 ***dA cus A Koritus Susa 113 & $493 dorcus A anºs Ahy con var A Incorpkyras brasa doch bpet bardsrosins lado Chua 104} immuta payponen a var cand densis ** Sootbera Cars * 2 * rar seus su da ces About indexsius REFERENCES Abit R (1003) Ind Wed Go 38 246-79 ADISUBIRAMANLAX TS and LEDIKLAYIKLAN IC (1943) / 3 1 113 116 d Eastes + 1 ·CHAPTER IV SOME IMPORTANT FACTORS RELATING TO THE PREVALENCE OF MALARIA Continued existence of malaria depends on a variety of factors some of them being Distribution and prevalence of malaria Climate Plant life and malaria Immunity-race age sex and occupation Man mnade malaria 2S DISTRIBUTION AND PREVALENCE Malaria is a focal global disease and extends to 60 N latitude in Russia and 40 S in Argentine high as 9000 feet in Quito in Ecuador and as low as 1300 feet below the sea in the Dead Sea The distri bution of malaria in the world is usually divided in three zones vz the temperate zone (40 N to about 60°N with patchy distribution of malaria and benign tertian as pre dominant species and with little malaria in the correspond ing zone of the southern hemisphere) the subtropical zone (Tropic of Cancer to 40 N and corresponding zone of the southern hemisphere with autumnal epidemics and malig nant tertian as the common infection and benign tertian frequent in the malarious regions) and the tropical zone (Tropic of Cancer to Tropic of Capricorn with malignant tertian as predominating parasite wide distribution of the disease and in areas near the equator throughout the year) The Indian sub-continent with its greatest length north to south about 2000 miles and its greatest breadth from east to west about 1500 miles shows a very great variation of physical features In the wide range of its latitude and longitude it offers an Arctic climate in the snow-clad areas 15000 feet up in the Himalayas and a great belt of temperate and tropical climate lower down The winter isotherm at the foot of the Himalayas is about 50 F The ·SOZLE IMPORTANT FACTORS 29 plains of the north have extremes of climate bitterly cold in winter and blistering hot in summer The south remains hot throughout the year (winter 75 F suinmer 8 F) Rainfall varies from place to place from the world s highest record of about 430 inches at Cherrapunji in Assam to less than 6 inches in a year in Rajputana and the west The greater part of the Punjab (pre partition) contains rich alluvial sail brought down by the rivers while the southern tableland is composed of rocks with a thin layer of soul The western part of India and Malsa bave black cotton soll The Assam Valley between the Burma Hills and the Himalay as is 50 miles wide and 300 mules long and is full of detntus to a depth of about 3 miles The melting snow from the Himalayas gres rise to a 7 mile wide river the Brahmaputra Heat and moisture help thich forests like those of the Sunderbans to flourish at the mouth of the Ganges whereas heat with no moisture pervades the deserts in Rajputana and the west Depending on the fertility of the soul the population in the Indo Gangetic plain and on the Western and Eastern Coasts 25 very thick but u Sind and Rajputana sparse These widely different conditions of soil and clinate varying from snow bound rocks to warm Tell watered and ſertle valleys persuade men to sow differ ent crops by different methods to undertake different arriga tion and engineering projects They provide breeding places for different species of anopheline mosquitoes Knowles et al (1930) observe that zoographically the indian sub-continent differs from other malarious countries at all points except as regards the North East Fronter The Persan desert cuts it off from the malarial region of Mesopotamia in the west the Paris separate it on the north west from the malaria of the lower Oxus Valley whist to the north the Fumalay as and the immense tableland of Tibet at an elevation inhibitory to the disease separate at from the malunia that is known to occur in Sibena With the excephon of the North East Frontier the ocean bounds the remainder It must have been through the corridor of the Brahmaputra Vangtse that malaria entered the country hashmut which is the farthest point from the cotrance is comparatis els malaria free Plasmodium malanae the C+ ·32 INTRODUCTION TO MALARIA PROBLEM IN INDIA a careful low humidity and at low temperatures they do not bite They can however, he for long periods with infected blood meal and can convey the disease when the tempera ture rises again except when they are in a state of complete hibernation With high humidity the mosquitoes may not only live to allow the parasite cycle to be completed but to transmit the infection to several persons The minimum temperatures for continuous development of P malana P vivar and P falciparum are generally 165 C 175 C and 18 C respectively PLANT LIFE AND MALARIA Plants provide under certain circumstances protec tion and food to mosquito larvæ In gheels tanks ponds and numerous collections of water observer will find four different zones of vegetation A bottom zone (vital layer) of sut with microscopic plants putrefaction bacteria sulphur bacteria iron bacteria unucellular plants (the Diatoms) and blue green algæ the second zone of flowering aquatic plants rooted to the bottom layer (viz ribbon shaped green leaves with underground trailing stems of the Vallisneria spiralıs) The third zone is composed of floating and submerged vegetation The commonest water plants in India are the Hydrilla verticil lata Ceratophyllum demersum Mynophyllum tubercula tun Lagarosiphon Roxburghu Najas indica N foveolata Utricularia flexuosa v stellars and others Finally the fourth zone is composed of numerous floating and amphi bious plants The floating vegetation may be non flowering svater plants or minute flowering plants like Wolffia Lemna and Azolla (which incidentally serve as food for fish) But often these non flowering or minute flowering plants are replaced by larger plants such as Pestra stratiotes Salvinia cucullata and water hyacinth These large plants provide support to various types of amphibious vegetation like Jus, stea repens Ipomea reptans Enhydra fluctuans and Hygrorhiza anstala etc The vegetation of allowed to grow unchecked forms a dense canopy on the surface of the water The activity of the putrefying bacteria and Schizomycetes of the vital layer converts rotten vegetation ·SOME IMPORTANT FACTORS 33 and organic matter into nutrient salts and provides in exhaustible food for the growth of plants Dense vegetation consequently develops and puts an end to the life of various fresh aquatic fauna like cyclops copepods rotifers para mecium amoeba and other lower members of the animal kingdom (These smaller members form food for crusta ceans fish etc) The adverse effect on the various fauna is mainly due to absence of light and oxygen and the pre sence of gases The association of various types of vegeta tion with breeding places of various species of mosquitoes has not yet been thoroughly investigated but there is no doubt that further researches will soon establish intimate relation of various species of mosquito with different types of aquatic growth Reference has been made (while dis cussing bionomics of the different species) to the fact that breeding places of A philippinensis larvæ are associated with Hydrilla verticillata Ceretophyllum demersum Ulr culana Najas and non holding masses of filamentous green algae Duckweed water hyacinth blue green alge such as Anabæna Oscillatona Mycrocystis ærugenosa and Euglena and other flagellates appear to render the collec tions of water unsuitable for breeding places of A philip pinensis larva A Sundatrus is often associated with vegetation such as algæ (Enteromorpha Cladophora Cz nophycea) Oscillatoria germinata "Lyngby a Confer loides Oedogonium and dead aquatic vegetation (Poto mogenton pectinatus Halophila ovata and the well known brackish water blue green algæ Lyngbya estuari) А annulans like a philippinensis is found associated with floating vegetation composed of Hydrlla verticillala Cera tophyllum demersum and algae growth mainly of spirogyra ramsazi is found occurring with Pastia stratiotes (Buskas 1940 1944 1945) IMMUNITY It is common experience that some patients suffer ing from malana spontaneously recover without any form of specific treatment Spontaneous recovery of the patient infected with malaria parasites points to a very efficient defence mechanism in the body Experiments on thesus ·32 INTRODUCTION TO MALARIA PROBLEM IN INDIA cai low humidity and at low temperatures they do not They can, however live for long periods with infe blood meal and can convey the disease when the temp ture rises again except when they are in a state of com hibernation With high humidity the mosquitoes may only live to allow the parasite cycle to be completed to transmit the infection to several persons The minin temperatures for continuous development of P mala vivar and P falciparum are generally 16 5 C 17! and 18 C respectively PLANT LIFE AND MALARIA Plants provide under certain circumstances pri tion and food to mosquito larvæ In gheels ta ponds and numerous collections of water, a observer will find four different zones of vegetat A bottom zone (vital layer) of silt with microscopic pl putrefaction bacteria, sulphur bacteria iron bact unicellular plants (the Diatoms) and blue green algae second zone of flowering aquatic plants rooted to the bo layer (viz ribbon shaped green leaves with undergra trailing stems of the Vallisneria spalıs) The third : is composed of floating and submerged vegetation commonest water plants in India are the Hydrilla ver lata Ceratophyllum demersum Mlynophyllum tuber tum Lagarosiphon Roxburgh. Najas indica N foveo Uinculana flexuosa U stellars and others Finally fourth zone is composed of numerous floating and an bious plants The floating vegetation may be non flow water plants or minute flowering plants like Wolffia Le and Azolla (which incidentally serve as food for fish) often these non flowering or minute flowering plants replaced by larger plants such as Pistia stratiotes Salı cucullata and water hyacinth These large plants pro support to various types of amphibious vegetation like suæa repens Ipomoea reptans Enhydra fluctuans Hygrorhiza anstata etc The vegetation of allowed to unchecked forms a dense canopy on the surface the water The activity of the putrefying bacteria Schizomycetes of the vital layer converts rotten vegeta ·SOME IMPORTANT FACTORS 33 and organic matter into nutrient salts and provides in exhaustible food for the growth of plants Dense vegetation consequently develops and puts an end to the life of vanous fresh aquatic fauna like cyclops copepods rotifers para mecium amoeba and other low er members of the anual kingdom (These smaller members form food for crusta ceans fish etc) The adverse effect on the various fauna is mainly due to absence of light and oxygen and the pre sence of gases The association of various types of vegeta ton with breeding places of various species of mosquitoes has not yet been thoroughly investigated but there is no doubt that further researches will soon establish intimate relation of various species of mosquito with different types of aquatic growth Reference has been made (whuile discussing bionomics of the different species) to the fact that breeding places of A philippinensis larvæ are associated with Hydrilla verticillata Ceretophyllum demersum Ulrs culana Najas and non holding masses of filamentous green algæ Duckweed water hyacinth blue green algæ such as Anabana Oscillatoria Mycrocystis erugenosa and Euglena and other flagellates appear to render the collectons of water unsuitable for breeding places of A philip pinensis larva A sundarcus is often associated with vegetation such as algæ (Enteromorpha Cladophora Cynophycea) Oscillatona germinata Lyngby a Confer Lordes Oedogonium and dead aquatic vegetation (Polomogenton pectinatus Halophila ovata and the well known brackish water blue green alga Lyngbya æstuari) A annulans like A philippinensis is found associated with floating vegetation composed of Hydrolla verticillata Cera tophyllum demersion and alga growth mainly of spirowyra A ramsayı as found occurring with Pastia stratiotes (Biswas 1940 1944 1945) TUNITY It is common experience that some patients suffer ing from malaria spontaneously recover without any form of specific treatment Spontaneous recou cry of the patient infected with malana parasites points to a very efficient defence mechanism in the body Experiments on thesis ·32 INTRODUCTION TO MALARIA PROBLEM IN INDIA low humidity and at low temperatures they do not bite They can however live for long periods with infected blood meal and can convey the disease when the tempera ture rises again except when they are in a state of complete hibernation With high humidity the mosquitoes may not only live to allow the parasite cycle to be completed but to transmit the infection to several persons The minimum temperatures for continuous des elopment of Punalaria Purvar and P falciparum are generally 16 5°C 175C and 18 C respectively PLANT LIFE AND MALARIA Plants provide under certain arcumstances protec tion and food to mosquito larva In jheels tanks ponds and numerous collections of water, a careful observer will find four different zones of vegetation A bottom zone (ital layer) of silt with microscopic plants putrefaction bacteria sulphur bacteria iron bacteria unicellular plants (the Diatoms) and blue-green algae the second zone of flowering aquatic plants rooted to the bottom layer (viz nbbon shaped green leaves with underground trailing stems of the Vallisneria spirals) The third zone is composed of floating and submerged vegetation The commonest water plants in India are the Hydnila zerficil lata Ceratophylum demersun 23 nophyllum tubercula tun Lagarosiphon Rorburgh! Majas indica N fovcolata Uirculana fier rosa y sicians and others Finally the fourth zone is compo-cd of numerous floating and amphi bious plınts The floating vegetation may be non fosering water plants or minute flossering plants like Wolffia Lemna and Azolla (which incidentall serve as food for fish) But often these non flowenng or minute flowering plants are replaced by larger plants such as P sta stratiotes Salvınja che Vata and water hmcinth These large plants provide support to various types of amphibrous vegetation like Jus SKTA tehers Ipomoea reptans Enhydra fluctuans and Higrorhiwa anstati etc The vegetation of allowed to grow uncheched forms 1 dense canopy on the surface of the water The activity of the putrefying bacteria and Schizomycetes of the vital layer converts rotten vegetation ·SOME IMPORTANT FACTORS 37 What 3 other buman beings by about the end of third week А few cases of malaria thus occur by the end of the fifth week The persons now infecfed produce large number of game tocytes by the end of the sixth week and infect many mosquitoes The infected female anophelines in their turn are able to infect many persons by the end of the eighth Week Thus by the end of the tenth week from the initial laying of eggs an outbreak of large number of malaria cases occurs The subsequent events depend on the conditions favourable for propagation and longevity of the carrier species communal immunity and facilities for the spread of infection From the above very brief account the complexity of the malaria problem is obvious The principal factors not only differ between districts of the same State but also in rural and urban localities of the same district The same species of mosquito may behave differently under different conditions VIZ A maculatus a dangerous vector in Malaya is relauvely innocuous in India A philippinensis is found in human habitations in Bengal but rests in cattle sheds in Assam It is probable that these are biologically distinct races of the same species Strains of malaria para sites show a wide variation A community may be rela bvely immune to a particular strain of a species of malaria parasite and show a very low incidence of malaria but a foreign strain may precipitate an epidemic if circumstances are favourable for the spread of infection It is essential to study and make a survey of each locality before attributing incidence of malaria to any of the factors referred to above, Different species of anophelines may require different control It is easy to understand how immense harm can be done by putting embankments railways roads drains and barrages in places where from malaria point of view they are not desirable by selecting a site for habitation with put a previous malaria sursey of the locality by leaving borrow pits and brickfields unattended thereby increasing breeding places for mosquitoes by faulty methods of imnga ton by injudicious house construction by imperfect drain ange or sewage system and by uncontrolled aggregation of a measures Large population 1 ·36 INTRODUCTION TO BIALARIA PROBLEMI IN INDIA natural surroundings were carried out The hill section of the Bengal Assam Railway is an outstanding example where jungles were cut down and graves took their places It is stated that one man died for every sleeper laid MALARIA FORECAST For malaria to spread there must be infected persons with sufficient number of malaria parasites fernale anophe lıne mosquitoes with facilities to breed and bite human beings and the presence of susceptible individuals Epide mics occur when a large number of non minune persons enter into a locality or if a foreign strain of malaria parasite is introduced into a community In areas where reinocula tion practically throughout the year does not take place seasonal epidemics occur if there is an increase of the infec tive vector with facilities for spread of infection The Punjab (pre partition) Health Department used to forecast the probable incidence of malaria every year in the begin ning of September The method of forecasting was based on the hypothesis that malarja epidemics occur due to the loss of equilibrium between infection and immunity consequently involving the consideration of humidity spleen rates epidemic potential and economic factors An excessive rainfall in July and August extensive floods a relatively high epidemic potential factor (above 60) a low spleen rate in June and a famine or relatively higher price during the preceding year give warning of the onset of an epidemic Such forecasts based on the above mentioned factors, have proved of immense value to warn in good time the areas likely to be affected (Butt 1944) - EPIDEMICS The sequence of events in epidemics may be sum marised as follows The surviving malaria carrying mos quitoes lay eggs By the end of a week or ten days adult mosquitoes Temerge They may take blood feed from human beings who are gametocyte carriers The number of such camers however is low at this stage The fes female anopheline with infected blood feed are able to infect ·CHAPTER V ELIVINATION OF BREEDING PLACES Effective anti malaria measures include measures to prevent infective species of mosquitoes from breeding offensive campaign against mosquitoes in all stages of development careful defensive action to protect human beings from the bite of mosquito and administration of drugs to kill the parasite injected into the system by mosqui toes that survive offensive action and penetrate defences Man made breeding places in fields and firetins borrow pits and brickfields tubs and tanks roads railways and the like and those in nature like swamps seepages etc can be readily eliminated by simply ensuring adequate drainage of water and by preventing water from collecting SWAMPS AND SEEPAGES Rain water either flows down the earth as surface water and runs in streams rivers and ultimately into the sea or percolates into the earth emerging lower down as seepages and swamps Usually some of it runs as surface water and the remainder sinks into the earth Such collections of water can be got rid of by a well planned system of drain age. The drainage may be open on the surface or subsoil leading from subsidiary drains to the main drain Surface or open drains should be narrow with sides free from vegetation and with adequate fall and depth and rounded bottom Subsidiary drains or tributaries should join it at an acute angle In swamps they can be made to fun parallel or in herring bone arrangement In foot hulls It is best to mark out soon after a shower of rain areas of highest springs and seepages and then to dig a contour drain of adequate size (usually 4 decp 6 wide at the top and at the bottom) at night angles to the flow of water Excavated earth should be thrown at least so behind the drain Drains have been excavated in the U.SA and Palestine by laying dynamite charges I feet apart in holes (Siensson) This method has been 4 down the foot hill ·38 INTRODUCTION TO MALARIA PROBLEM IN INDIA The infectivity of the anopheline and the factors discussed above alone do not always explain the abnormally high incidence of the disease All possible associated fac tors have therefore to be investigated For example overlapping of two species like A leucosphyrus and A minimus in Assam and habaw Valley lead to serious results One specie may appear for a short period but can commence transmission early raising the gametocyte rate in the local population, consequently when the other specie appears it starts intensive transmission REFERENCES BISWAS K (1940) Science and Culture 11, 327 330 Idem (1944) Ibid 9, 426-428 Idem (1945) Personnel communicakon BUTT A H (1944) Personnel communication KNOWLES R SENIOR WHITE RAND DAS GUPTA BM (1930) Ind 1 Jed Res Special Memoirs 18, 138 139 TALIAFERRO W HAND MULLIGAN HW (1937) Ind Wed Res Memoir No 29 118 ·ELIMINATION OF BRCEDING PLACES 41 increasing the outlet helps to get rid of the collection of water It is however emphasised that it is not necessary to drain all pools and swamps sf larvæ are not found breed ing in them Injudicious construction of drains in areas where the vector mosquito breeds in running streams 1> obviously dangerous In some arcas with moderate mon soon rainfall bunds are put so that rain water is directed to 1 single Lido or depression BORROW PITS AND BRICKFIELDS It is a common practice to dig earth for the construction of roads railways canals embankments and in brick hiin areas leaving behind vast pits below the drainage level If the carth is so excavated as to Icare an even slope no water will collect Where such a procedure is not possible the pits can be dug in series connected with each other and sloped so that no water is able to accumulate Partial filling may be required in places to ensure a proper gradient A note of warning may again be given that draining of the pits by connecting them can lead to dangerous breeding places in areas where the infectie vector breeds in drains with grassy edges and running water In such areas it may be possible to break the imperious stratum and make Vertical drains Filling in of pits is ideal but the cost is often prohibituse QUARRIES Quarries Icare numerous depressions Quarrying should be done vertically so that the face is only very slight I undermined (preferably not at all undermined) leaving no chance for water to collect HOLES IN TREES ROCKS AND SAND Holes in trees and rocks require filling with earth Crab holes and the like may be filled with Paris green sind or carth HIELDS Tields with wet cultivation may be associated (espe cially in the case of imigation channels in the nice fields) with anaları Fields flooded with silt are less liable to ·40 INTRODUCTION TO MALARIA PROBLEM IN INDIA found not only labour saving but also quick The drains may be built with or without lining Pukka cement or stone is not absolutely necessary for more than 3' above the normal flowing water level in the drain If the storm water drain is intended to carry sullage in addition to rain water the whole drain should be lined and provided with central cunette for carrying the perennial flow giving the least breeding surface The un lined drains often get damaged and require constant atten tion in cleaning and grading These drains can also be made of circular pipes 4 to 12 in diameter 1 to 2 long or open concrete inverts can be laid and covered with gravel and earth and thus prevent rain from damaging the top The laying out of sub soul drains requires skilled labour Initial cost is high but recurring expense is losy They can be easily supervised Faggot or fascine drains have been successfully used in Malaya and Africa (Watson, 1942) on a large scale Drains are filled with lengths of cut bamboos complete with leaves as they are cut from the trees In a mine in Africa these covered drains were made in 1932 and were found working well for long periods up to 1939 without any repairs or upkeep Stone packed drains can also be made They often require renewal Sub drainage has been used in Kangra Valley and has turned a highly malarious water logged area into a cattle grazing ground free from malaria (Raina 1946) All that was done was to dig kutcha surface drains they were covered with fat stones and earth and grass was planted on top At times it is difficult to drain collections of water lying over an impervious stratum In some cases a pit can dug and a shaft driven vertically down through the impermeable stratum Stones are packed round the shaft These vertical drains in selected suitable places effectively accelerate percolation of water The number of such serta cal drains depends on the size of the area to be drained In a few cases all that is required is to submerge or to flood the swamps by putting weir lower down These can be sluiced or larvæ can be dealt with by a suitable antlarval method Invariably the rule of decreasing the inlet or ·ELININATION OF BREEDING PLACES 41 increasing the outlet helps to get nd of the collection of water It is however emphasised that it is not necessary to drain all pools and swamps if larvæ are not found breed ing in them Injudicious construction of drains in areas where the vector mosquito breeds in running streams is obviously dangerous In some areas with moderate mon soon rainfall bunds are put so that rain water is directed to a single Lido or depression BORROW PITS AND BRICKFIELDS It is a common practice to dig earth for the construction of roads railsays canals embankments and in brick kın arcas leaving behind vast pits below the drainage level If the earth is so excavated as to leave an esen slope no water will collect Where such a procedure is not possible the pits can be dug in series connected with each other and sloped so that no water is able to accur late Partial flling may be required in places to ensure a proper gradient Å note of warning may again be given that draining of the pits by connccting them can lead to dangerous breedin. places in arcas where the infectie vector breeds in drains with grassy edges and running water In such areas it may be possible to break the empervious stratum and make Vertical drains Filling in of pits is ideal but the cost 15 often prohibituse QUARRIES Quarties leare numerous depressions Quarrying should be donc vertically so that the face is only very slight ly undermined (preferably not at all undermined) leaving no chance for water to collect HOLES IN TREES ROCKS AND SAND Holes in trees and rocks require filling with carti Crab holes and the like may be filled with Paris green sand or earth CIELDS Tields with set cultivation may be associated (espe cially in the case of imgation channel in the nice field) with maların Tields flooded with silt are less liable to ·42 INTRODUCTION TO MALARIA PROBLEM IN INDIA breed mosquitoes The incidence of malaria may depend on the methods of unigation Perennial irrigation channel: from canals give rise to seepages and water logging ano inundation irrigation leaves pools after the flood subsides Counter drainage good maintenance of channels and sluice gates and restrictions on water supply can reduce the number of breeding places considerably Channel banks should be protected if necessary by fencing Disused water courses should be filled in as far as possible Intermittent drying of fields reported by Russell has proved a great success in South India where rice fields are kept dned for two days in the week Kalandadze and Sagatelova (1944) have drawn attention to the fact that anopheline eggs or larvæ may not die unless drying is absolutely complete as in the presence of slight moisture the eggs especially anopheline eggs can survive for over a week Intermittent flooding has not only reduced the number of breeding places but has in many cases improved the yield of crops PIPES Piped water supply for irrigation or domestic usc requires constant supervision of hydrants storage tanks and stand pipes Hydrants and sluice valves should not leak A concrete platform with a proper drain to allow the water to run off should be provided round hydrants and stand Pipes WELLS TANKS AND SWIMMING POOLS Wells can be rendered innocuous by introducing Jarvivorous fish or sealing the top with concrete and lifting the water by means of a pump A mosquito-proof cast iron inspection door can be incorporated in the concrete seal All water cisterns similarly require well fitting lids and the side holes must be closed in all cases to prevent entry of mosquitoes Water in the swimming pools etc should be changed weekly DRAINS Domestic and sewage drains require special attention ·ELIAIVATION OF BREEDING PLACES 43 As far as possible they should not cross the road or neighbouring houses They can be made of semi-cylindrical glazed pipes or concrete hakies The terminal drains can be rendered mosquito-proof by covering the last 75 with concrete If the connection is made with a pipe of 6 diameter a 12 lett off set effectively presents the entering of mosquitoes and consequently prevents breed ing The same principle holds good for ventilation shalts Ventilation shafts of dimensions of more than 6 diameter will requirc mosquito-proofing The main drains are kisually 8 wide at the top 2 at the bottom and 5 Jeep SEWAGE DISPOSAL Sewage disposal (except when in the sea or large filers) requires constant supervision A slephenst has been reported to breed in sewage contaminated water ROADS AND RAILWAYS Embankments put across natural drainage lead to the ause of sulysoil water and obstruct the flow of storm water and thus lead to numerous collections of water ANI embankments across the natural line of drainage should be avoided Drains should be prouded on cither side of the embankments so that any water likely to collect is drained off in road and milsay constructon the problem of embankments requires serious consideration А sufficient number of bridges and cul crts with inserts placed at correct level can present collections of water Collec tions of water on roads built under bridges may require pumping out DANS AND BARRATES Dams and barrages often gilt risc to a number of breeding places Drainage of os crflox presention of leaks and provision for rapidh lowering the level of water in im pounded waters help considerably in reducing mosquito breeding JUNGLF CLEIRACE Inde criminate clearing of jungle 15 dangerou Bionomics of the mosquitoes hould be studied ·42 INTRODUCTION TO MALARIA PROBLEM IN INDIA breed mosquitoes The incidence of malaria may depend on the methods of irrigation Perennial irrigation channels from canals give rise to seepages and water logging and inundation irrigation leaves pools after the flood subsides Counter drainage good maintenance of channels and sluice gates and restrictions on water supply can reduce the number of breeding places considerably Channel banks should be protected if necessary by fencing Disused water courses should be filled in as far as possible Intermittent drying of fields reported by Russell has proved a great success in South India where rice fields are kept dried for two days in the week Kalandadze and Sagatelova (19.14) have drawn attention to the fact that anopheline eggs or larvæ may not die unless drying is absolutely complete as in the presence of slight moisture the eggs especially anopheline eggs can survive for over a week Intermittent flooding has not only reduced the number of breeding places but has in many cases improved the yield of crops PIPES Piped water supply for irrigation or domestic usc requires constant supervision of hydrants storage tanks and Hydrants and sluice valves should not leak A concrete platform with a proper drain to allow the water to run off should be provided round hydrants and stand Pipes WLLLS TANKS AND SWIMVING POOLS Wells can be rendered innocuous by introducing larvivorous fish or sealing the top with concrete and lifting the water by means of a pump A mosquito-proof cast iron inspection door can be incorporated in the concrete seal All water cisterns similarly require well fitting lids and the side holes must be closed in all cases to present entry of mosquitoes Water in the swimming pools etc should be changed weekly DRAINS Domestic and sewage drains require special attention stand Pipes ·ELIMINATION OF BREEDING PLACES 43 As far as possible they should not cross the road or neighbouring houses They can be made of semi-cylindrical glazed pipes or concrete halses The terminal drains can be rendered mosquito-proof by covering the last 75' with concrete If the connection is made with a pipe of 6 diameter a 12 fect off set effectively prevents the entering of mosquitoes and consequently prevents breed inr The same principle holds şood for ventilation shafts Ventilation shafts of dimensions of more than 6 diameter will requirc mosquito proofing The main drains are usually 8 wide at the top 2 at the bottom and 5 deep SEWAGE DISPOSAL Sewage disposal (except when in the sea or large rivers) requires constant supervision A stephenst has been reported to breed in sewage contaminated water ROADS AND RAILWAYS Embankments put across natural drainage lead to the Tise of subsoil water and obstruct the flow of storin water and thus lead to numcrous collections of water All cmbankments across the natural line of drainage should be avoided Drains should be provided on either side of the embankments so that any water likely to collect is drained off in road and railway construction the problem of embankments requires serious consideration А suficient number of bridges and culverts with inserts placed it correct level can prevent collections of water Collec tions of water on roads built under bridges may require pumping out DANS AND BARRAGES Dams and barrages often ghe rise to a number of breeding places Drainage of overflon presention of leaks and provision for rapidly lonering the level of water in un pounded waters help cons derably in reducing mosquito breeding JI VCLE CLEARANCE Indiscriminate clearing of jungle is dangerous Bionum es of the mosquitous should be studxd ·44 INTRODUCTION TO MALARIA PROBLEM IN INDIA DRY DAY There are numerous breeding places that can be elımı nated by every individual Pots and pans tins and bottles should not be carelessly thrown away Small collections of water in pits and pools in and around houses should be filled or drained It should form a rule in every home to empty all vessels containing water like chattes buckets etc at least once a week In public institutions like schools offices and municipalities a dry day every week should be observed The object of this measure is that on one day in the week every place is kept completely dry for a short time A thorough inspection of the whole area within fixed hours should be carried out to ensure that no collection of water has been overlooked REFERENCES COVELL G (1941) Antt mosquito measures with special reference to India Health Bulletin No II Malaria Bureau No 3 Manager Publication Delhi KALANDADZE L P AND SAGATELOVA (1944) Trop Dis Bull 41 916 RAINA BL (1946) Anti malana measures Yol hangra Valley (not published) SVENSSON RA handbook of malarsa control Shell Book O: Companies WATSON M (1942) Some Emergency Ant Malarial Aleasures Ross Institute Industrial Advisory Committee 6 ·CHAPTER VI ANTI LARVAL MEASURES Before starting antı larval measures it is necessary to study the local breeding places the ecology of the mosquitoes particularly the vector species Nuch time labour and money can be saved if those places only are treated which breed mosquitoes especially the vector species It may be added that in an area other species of mosquito though not responsible for carrying malaria have great nuisance value especially during the spring in the plains and their breeding should also be con trolled The areas to be controlled will depend on vanous factors including species of anopheline mosquito the nature of the breeding places the prevailing wind distance of human habitation from the breeding place etc It may be stated as a general rule that control over an area up to at least half a mile round an inhabited locality gives satisfactory results Ribbands (1911) however points out that the risk of getting infection is negligible if five miles and is small if two miles intervene between the camp and any infected locality Risk of getting infection however increases if there are breeding places between the infected area and the area to be protected or the number of residents in the locality is small Raevsky and his colleagues (1944) have reduced the risk by putting cowsheds and animal houses on the leeward side between the breeding places and human habitation (mosquitoes start feeding on cattle instead of men) The animal sheds are put not less than 200 meters from the human habitation (piggenes 250 m ) The animal houses should be separated from each other by following gaps bytes 50 meters pigsties 45 meters sheep pens 50 meters apart with doors on the leeward side There should be vegetation between the barrier and human dwelling Cattle must return froin grazing not later than half an hour before sunset Anti larval measures wherever feasible should be permanent Temporary measures invariably prove ·44 INTRODUCTION TO MALARIA PROBLEM IN INDIA . DRY DAY There are numerous breeding places that can be elimi nated by every individual Pots and pans tins and bottles should not be carelessly thrown away Small collections of water in pits and pools in and around houses should be filled or drained It should form a rule in every home to empty all vessels containing water like chattes buckets etc at least once a week In public institutions like schools offices and municipalities a dry day every week should be observed The object of this measure is that on one day in the weeh every place is hept completely dry for a short time A thorough inspection of the whole area within fixed hours should be carried out to ensure that no collection of water has been overlooked REFERENCES COVELL G (1941) Antt mosquito measures with special reference to India Health Bulletin No II Malana Bureau No 3 Manager Publication Delhi KALANDADZE L P AND SAGATELOVA (1944) Trop Dis Bull 41 RAINA BL (1946) Ant malaria measures Yol Kangra Valley (not published) SVENSSON R A handbook of malana control Shell Book Oil Companies WATSON M (1942) Some Emergency Anti Malana! Vcasures Ross Institute Industrial Advisory Committee 6 916 ·CHAPTER VI ANTI LARVAL MEASURES Before starting anti larval measures it is necessary to study the local breeding places the ecology of the mosquitoes particularly the vector species Much time labour and money can be saved if those places only are treated which breed mosquitoes especially the sector species It may be added that in an area other species of mosquito though not responsible for carrying malaria have great nusance value especially during the spring in the plams and their breeding should also be con trolled The areas to be controlled will depend on various factors including species of anopheline mosquito the nature of the breeding places the prevailing wind distance of human habitation from the breeding place etc It may be stated as a general rule that control over an area up to at least half a mile round an inhabited locality gives satisfactory results Ribbands (1944) however points out that the risk of getting infection is negligible if five miles and is small if two miles intervene between the camp and any infected locality Risk of getting infection however increases if there are breeding places between the infected area and the area to be protected or the number of residents in the localty is small Raevshy and his colleagues (1944) have reduced the risk by putting cowsheds and animal houses on the leeward side between the breeding places and human habitation (mosquitoes start feeding on cattle instead of men) The anunal sheds are put not less than 200 meters from the human habitation (piggeries 250 m) The animal houses should be separated from each other by following gaps byres 50 meters pigsties 45 meters sheep pens 50 meters apart with doors on the leeward side There should be vegetation between the barrier and human dwelling Cattle must return from grazing not later than half an hour before sunset Anti larval measures wherever feasible should be permanent Temporary invariably prove measures ·46 INTRODUCTION TO MALARIA PROBLES IN INDIA expensive the long run due to the recurrin expenditure Temporary measures horreter, will be required : many places dunng the construction of works collection o large number of people for a short period and during the interim penod when permanent measures are being made Ant larval measures can also be naturalistico chemical NATURALISTIC Naturalistic or biological measures aim at so altering the natural conditions as to render the place unsustable for breeding The following methods have been successfully used against Sarvæ of different species Sluicing flooding sifting agitating the surface of water changing its level etc Deep shading Pollution Changing the salt content Alteration of food supply Larvis orous fish Slucicing The sluicing is only an imitation of nature s method of flushing down the larvæ water of a stream is dammed and released at inter als by esther hand-operat ed sluice gates or by automatic siphons Sluice gates were first used by Graham at Lucknow in 1913 in the rzer Gumti They were popularised as malaria control measure by Prof K B Williamson who used them between 1930 32 in Malaya against A maculatus By 1937 about 200 streams along 15 miles of hills in Penang were being suc cessfully flushed By the force and disturbance of water larvæ are washed down and stranded In some cases eges and pupa drift to the banks lower down and require fur ther treatment Blacdonald designed an automatic siphon incorporating DeVillier s siphon with full flush of 475 gallons per minute at a cost of Rs 25/ siphor The main parts of DeVillier s siphon ar oil drum on three concrete blocks a mair 1

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·18 INTRODUCTION TO VALARIA PROBLEU IN INDIA In small streams earth dams with one or more oil drums the ends of such had been removed to form an opening through the dam for releasing the flush have been used in South India The upper end of the drum is kept closed by a sheet of wood unul the dam is full then the wood is removed by hand and the stream is flushed Various other sluice gates (like drums fixed eccentrically so that they tilt immediately they are filled up with water and resume vertical position when empty) have been improvised at a very low cost ( Watson 1942) The pipeless siphon used in Tea Estates is a great im provement The poncple on which they work is that when the water rises in the catchment area it flows over the weir and falls into the sealing trough below at the outflow taking ait with it When water falls in the trough some of these bubbles come up on the outside of the trough thereby causing a partial vacuum inside the siphon This unequal pressure between the outside and the inside of the siphon starts the flow of water expelling all the air inside the siphon When the water level in the catchment area falls sufficiently low to admit air to enter at the inlet the vacuum is removed and the siphon immediately shuts off until the water level rises and the cycle again com Atmospheric balancing valves are placed at the highest point of the siphon so that by opening these valves the siphon may be stopped at any stage of working (Ramsay 1944) These siphons may be of any size and shape depending on the quantity of water to be released Water released must not exceed the amount normally carned during floods Like all measures sluicing has its limitations Site and distance between the series of slasce gates in a stream will vary with different places Flooding Floods with silty water have been noticed to reduce the incidence of malaria Rise of water level in Bengal is a good example Sinha (1940) gne seven reasons in favour of a flood flush scheme viz it maintains during the rainy season flow of silty water in the drains ditches water channels pools borros pits and loss lying areas as a result of which mosquito breeding is easily and mences

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·To face page 19)
PAVO
FO
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Lone Ray Ant Mal ral Veasu
by Sr Malcolm Watson
Ro
In t tute
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·ANTI LARVAL MEASURES
AUTOMATIC PIPELESS SIPHOV
CROSS SECTION
PLAN
effectively. checked The low lying areas small pits and
depressions are gradually filled up by sult deposit It helps
local drainage by discharging water when the tide is low
It feeds numerous tanks and ponds with good nver water

·52 INTRODUCTION TO MALARIA PROBLEV IN INDIA Widely divergent views are held regarding the utility of indigenous fish * Hachet pointed out that the local fish after centuries reach a balance regarding their natural enemies and the number cannot be artificially increased and maintained at an abnormally high lesel of density whereas if exotic fish can be acclimatised they will prol ferate and maintain their number at abnormally high level On the other hand Fry Hora Prasad Sweetnam and Meyers advocate the use of indigenous fish and condemn the use of exotic fish on biological grounds There is enough evidence to believe that some indigenous fish like Panchax Aplocheilus Aphanous and Schizothorax pro gastus are equally larvivorous as exotic genera Larvivorous fish have their limitations In temporary collections of water or in places used as permanent fisheries their use is not recommended Prasad and Hora suggest that for fish to be effective all vegetable matter and debris that may prevent access of fish to mosquito larvæ should be removed This means that areas of water to be treated should be kept clean and in as much sanitary condition as possible (a) all predatory fish should be removed (b) disconnected pieces of water separated by short distances such as borrow pits etc should be connected by a regular drainage system so as to enable the fish to wander every where (c) shallow pits and pools should be either filled up or deepened so that fish may be able to live in them even when the water is at its lowest level in the dry weather and (d) fishing should be strictly prohibited in such areas For effective biological control of larvae by fish it is essential to know the buonomics of the mosquito and ecology and biology of the fish The importance of fish in malaria control has been established for a long timp but the habits of the various indigenous fish have not been scientifically studied in detail and have cot beert tried on a large scale in the field agents and to determine the utility of various indigenous species Prasad To prove conclusively the part that fish play as larvicadal and Jora (1936) suggested that as a preliminary measure two adjoining areas one heavily intested with malaria and the other comparatively free from it should be selected to sectaire na lane regasd bring paid to turn correlation that may exist between the probable density of population of the mosquito larvæ in the different areas of the locality and the types of fish and density of their population in the same kinds of water Observations should also be made of the natural food of various types of fish by an examination of their stomachs ·AX71 LARI 41 VEASURES 53 Covell enumerates the following requirements (based on Chaudhury s paper) for useful larvivorous fish They must be small so that they can get about in the shallon water among weed etc They must be hardy and flourish both in deep and shallow water They must be able to breed freely in confined water areas They must be able to stand transport and handling They must be difñcult to catch and able to escape theu natural enemies including man They must be absolutely worthless and insignificant as food They must be top feeders and cartuvorous Gambusra satisfies the above conditions and is at present readily available from the Malaria Institute of India Delhi CHEMICAL Oil Pars green Pyrethruin Oils Paris green pyrethrum and DDT are common larviades Cuprous Cyanide has also been used and found to be satisfactory as a larvide under certain climatic conditions Paraforma! dehyde soap cresol commercial cyllın creozote carbohc acid and borax have been used as larvicides but are not in use 101 Nesterwodskaja and Lubinski (1944) have re ported that phenothiazme (7 and 14 ounces per acre at 12 23 C) kılls All mosquito larvae in 48 hours Orling LO Howard in 1892 first recommended oils as larvicide and suggested that the film of oil mechanically stops the breathing of mosquito Sarvæ The land are killed not only by suffocation but also due to irritant and toxic action of oil mixtures Sir Malcolm Watson showed that mosquito breeding can be stopped even in running water by spraying the stream its banks and secpages with oil and pointed out that what is sold as crude oil or fuel ost varies greatly in composition in different parts of the world and that many of these oils do not make satisfactory anti walana mixtures Some would not kall lare some would ·56 INTRODUCTION TO MALARIA PROBLEM IN INDIA dusted by hand 5 per cent when dusted with blowers 15 to 33 per cent by aircraft have been used) Metcalf and Hess report that Anopheles quadrimaculatus larva can ingest particles of 29 51 68 and 106 microns in Ist 2nd 3rd and 4th instars respectively De Andre reports that best results are obtained with Paris green 2 microns in diameter The only guiding factor for the necessary strength of Paris green to be used is a practical test in the field If a particular strength is not found effective it should be increased Numerous substances have been used as diluents The commonly used diluents in India are ash screened road dust sand slaked lime soap stone powder cement dust and saw dust For large areas like streams heavy diluents are often suggested The diluents should be passed through a screener before use The vehicle and the Paris green used are thoroughly mixed in the required proportion generally in a rectangular galva nised iron box supported on two pillars The mixture is dusted usually with hand bellows or rotary blowers Paris green has been sprayed with success from aeroplanes-one pound of Paris green per acre is usually required Paris green may also be applied in liquid form Since Barber used the Paris green solution in Greece Russell and Jacob (1939) and other workers have used it successfully in India A stock mixture of kerosene oil } gallon Paris green 2. lbs castor oil 1 oz and white of 4-6 eggs shaken up in a pint of water can be used This mixture in dilution of 1 oz to I gallon of water can be used in a sprayer Pans green mixed with water (in dilution I in 500 or I in 250 suspen sion) has also been used (dose one gallon to 870 sq ft) effectively in shallow streams Dusting and spraying with Paris green is a cheap antı larval method and is specially suitable for fields and irriga tion channels Frequency of dusting depends on intensity of breeding and the climate If the development of the larvæ takes less than a week or so application every fifth day may be necessary in other cases application once a week gives quite good results It must be remembered that Paris green has no effect on eggs or pupa of mosquitoes and does not kill culicine larvæ when applied in the usual ·ANTI LARVAL MEASURES 57 method The use of Pans green has almost now been re placed by DDT Dichlor Diphenyl Trichlorethane (DDT) Its chemical synthesis was done as early as 1874 by a German chemist from Strassbourg In 1939 a firm in Switzerland R Geigy Company) during investigation for moth killing agents came across this chemical They prompty pro duced it under the name Gesaro In 1942 the Nex York Branch of Geigy Company recened 200 lbs of DDT from Switzerland The Department of Agriculture in Washington immediately got ut from Vew York Branch of Gergy Company and forwarded it to Orlando Laboratories It was soon found to have insecticidal properties against body lice In January 1943 chemists of the United States Department of Agriculture at Bolts alle Maryland Laboratories identified it as Dichlor Diphenyl Trichlorethane Following its identification in tensive research both in the field and the laboratories was taken up by British American Indian and other workers In a short tune it struch a death blow to insects carrying diseases in various theatres of war It was soon found to be lethal to mosquitoes lice fises bugs and vanous other 333Sects DDT is a white crystalline powder nearly insoluble in water moderately soluble in petroleum and vegetable osls and readily soluble in most organic solvents has 16 G per mmhlıtre density Crude commercial forms vary in purity and may contain only 60 to 77 per cent pure DDT {para para or pp DDT) PP DDT melts at 108 -9 C It has a characteristic and pleasant odour and a tendency to clump Exposure to tugh tem perature and humdity increases its tendency to clump It is toric to most crustacea and insects Ellis et al (1944) report that gold fish weighing 6-10 G die after taking pellets of DDT 63 200 magm per kgm body weight and frogs died after 40 to 72 hours on a single parenteral dose of 150 mg per kgm Rats and guneapigs after absorpuon of DDT through the skin showed toxic necrosis of the hver and Lidneys The lethal dose for animals varies from 150 to per kgra In pou de forma it has no 600 gr ·58 INTRODUCTION TO MALARIA PROBLEM IN INDIA 38 adverse effect on the skin of human beings and is quite safe to use Solubility in common solvents in per cent pp' DDT at 27-30 C is as follows Toluene Veg Turpentine 20 Malariol 9 Fuel Oil (Diesel) No 2 9 Fuel Oil (Diesel) No I 7 Kerosene Crude 7 Kerosene refined 4 Solution of required strength can be easily made by breaking up the lumps of DDT and then making a paste with the solvent It can then be poured into the container The container should at least be full of solvent Finally the remaining solvent is poured in the containers The solution in the container is kept in the sun and stirred with a stick (or by bubbling air with a power dnven air com pressor) The solution is ready for use in 3 days For immediate use DDT can be heated slowly on a hot plate and poured into the solvent when molten stirring all the time A37 per cent solution can be conveniently made as follows A four gallon tin is filled with commercial DDT up to 38' from the top This approximates 22 5 lbs of DDT Assuming that the powder contains 75 per cent of p'p DDT when it is dissolved in 45 gallons of the solvent the resultant solution approximates 3 7 per cent solution of pp DDT Its effect on eggs and pupæ is negligible but is lethal to larvæ and adult mosquitoes DDT as larutcide DDT is relatively non toxic to embryonic tissue It is interesting to note that there is selective absorption of DDT on the chitin in vitro Its larvicidal action is due to ingestion of the chemical or absorption or both As a control measure o 15 lbs (2 4 oz) of PP DDT per acre is found satisfactory DDT malarıol solution gives better results than DDT kerosene mixture It is observed that o 3 1b DDT per acre kills fish frogs snakes and other aquatic animal life Care therefore is required not to ·ANTI LARI AL MEASURES 59 ture exceed the strength of DDT in water used for breeding of fish The following have been used successfully (a) 7 ounces of DDT to i gallon of 3rd quality kerosene oil resulting in a 5% solution One quart of this solution is sufficient for one acre (b) o 1 lb DDT per acre in thuck segetation up to 1 lb per acre for dustang (c) 21 per cent to 3 7 per cent DDT solution in kero sene oil with approximate dosage of o 15 lbs of DDT spraying with Kent type pneumauc knap sack sprayer per acre (d) Five per cent DDT solution in lcrosene ori in a bamboo stump with one end of bamboo plaster ed with mud thrown in the middle of the pond Dosage o 2 lbs per acre (e) One handful of 2 per cent DDT powder mix Five pounds per acre (1) Sand or step bricks soaked in DDT thrown in stagnant water (g) 37 per cent DDT solution mixed with dry sand and made into balls thrown at intervals across water surface Balls made with mud are found ineffective Even one to two quarts of 5 per cent DDT solution per acre have been found effective The opinion is gaining ground that discrete application is preferable Five per cent solution in an oil of 46 dynes/cm spreading pressure gives good results on still waters Two ounces should kill all larvz wahun 25 feet radius re about 2000 sq feet DDT un emulsified solution have also given very good results Whatever the method used one must ensure that the breeding surface is completely covered in every case care should be tal en to distribute DDT uniformly especially along the water edge II spraying is done intermittently the intervals should not exceed 5 yards The density of vegetation and scum modify the effect for obtlous reasons Pouring by hand or garden syringes dusting or throwing sand and bricks are not so effective and economical as spraying with knapsack sprayer or stirrup pump In South ·60 INTRODUCTION TO MALARIA PROBLEM IN INDIA East Asia Command during the war DDT was extensively sprayed from aircraft 03 to o 6 lbs DDT per acre is usually effective 5 per cent solution of DDT were used singly or information flights- with several aircrafts abreast The dosage of 2 to 3 quarts per acre of the solu tion controlled mosquito breeding in swamps Full des truction of mosquito breeding in streams covered with vegetation was not possible The DDT deposited on vegetation however killed the mosquitoes coming to lay eggs and those which were newly hatched Application of DDT by aircraft has since been developed to a high degree Several types of aircrafts including helicopters with various types of equipment are now employed See also page 62 regarding DDT REFERENCES 80 273 ELLIS IM WESTFALL BA AND ELLIS M D (1944) Science Nov 24, 477 HORA S L AND MUKERJEE Table for identification of some Indian fresh water fish Manager Publication Delhi NESTERIVADSKAJA KM LABINISKI GA (1944) Tr Dis Bull 41, 103 PRASAD B AND HORA SL (1936) Rec Mal Suru Ind 8 631-646 RASKS 'GE (1944) T. Dis Bull 41 543 RAINA B L (1945) Ind Med Ga RAMSAY G C (1942) Report of the Committee of Control The Ross Institute of Tropical Hygiene India Branch Idcm (1944a) Ibid Idem (19.44b) Personnel Communication forwarding a note by J Robertson RIBRANDS CR (1944) ) Roy Army Medical Corps 82 157 64 RUSSELL P F AND JACAB V P (1939) JL Mal Inst Ind 2 261 271 SINHA JD (1940) Bengal Public Health Journal II 23 WATSON G (1941) Bull Ent Res 31 Part 4 WATSOV M (1942) Some Emergency Anti malanal Measures Ross Institute Industnal Adusory Committee ·CHAPTER VII ANTI MOSQUITO MEASURES VIZ Various methods of killing the mosquito have been used trapping swatting fumigating with sulphur dioxide cresol lysol Izal chlorine gas etc and spraying with pyrethrum DDT BHC An effective practical and popular method at present is spraying with DDT or Pyrethrum--DDT mixture Pyrethruin Le Prince and James in 1926 Ross in 1936 and Meillon in 1936 Covell Mulligan and Afridi in 1938 reported remarkable results by spraying pyrethrum solu tion One part of 2 per cent pyrethrum extract in 19 parts of third grade kerosene oil was recommended A very effective spray can be prepared by soaking one pound of dried powdered pyrethrum flowers in one gallon of kerosene ou for 72 hours provided the flowers are of good quality (Covell 1941) Many proprietary products containing Pyrethrum extracts are now available which are equally effective It is essential not only to spray the affected locality but also all buildings within about half a mile around it The spraying must be done thoroughly and systematı cally it is necessary to close all doors and windows open up all cupboards and almirahs etc (if any) and start spray ing with the spray directed upwards Direct hits on mos quitoes need not be aimed at Pyrethrum is a contact poison and its lethal action is most pronounced in atomised cloud The spraying in the room or hut should be conti nued till sufficient concentration of the wolution is produced (causing very slight imitation to the eyes) The quantity recommended is I OZ of spray per 1000 c ft of space The roomn should be left closed for about half an hour after the spraying The uninhabited huts or houses etc should not be neglected It is best to plan out a definite circuit for each set of houses Thorough spraying will be required in most places in the early morning not later than one hour after sunrise The principle of adult spraying is that malaria can ·62 INTRODUCTION TO MALARIA PROBLEM IN INDIA only be transmitted by the female anopheline mosquito which, having fed on a person with gametocytes in his blood succeeds in surviving for at least ro days and then has the opportunity of biting another susceptible human being The object is not so much to prevent human beings from being bitten by the mosquito as to reduce the longevity of the carrier species to such an extent that it cannot Ine long enough to become infective and as such cannot transmit malaria A very simple hand sprayer (MISH pattern) has been designed by the Malaria Institute of India Excellent results are obtained with petrol driven paint sprayers Electric sprayers of the same pattern are equally useful The American aerosol bomb is a great improvement o er the hand sprayers All that is required 15 to unscrew the cap over the nozzle of the bomb Immediately after the removal of the cap a fine must containing the insecticide fills the room Sesame oil acts as an activator of pyrethrum enhancing its insecticidal properties and Freon 12 (dichloro di fluormethane) acts as the propellant providing the necessary pressure to expel the insecticide About 4 seconds are required to spray a space of 1000 cubic feet Each bomb can effectively kill all flies and mosquitoes in 100 000 cubic feet DDT with an auxiliary solvent is now added to pyrethrum-Freon 12 solubon DDT The DDT is absorbed through the tarsi of adult mosquitoes and in a few hours the insect becomes inactive It gets tremors due to the neurotoxic poison and dies If the dose of DDT is small and contact time short the death may take 12 to 24 hours During the contact and the time of death it often shows increased activity and is not usually found near the place where it had the fatal contact The dry powder has no repellent action on the mosquito A5 per cent solution of DDT in 3rd grade kerosene oil is often used For killing adult mosquitoes optimum results may be obtained with 85 mgm P DDT per sq ft ie one quart of 3 7 per cent pp DDT solution per 500 sq ft With residual deposits of 100 to 200 mgm PP DDT per sq ft the residual fatal contact effect can be prolonged The residual effect is shortened on surfaces exposed to sunlight ·INTI YOSQUITO VEASURES 63 and rain porous and painted surfaces The residual effect has been reported to last several weeks and months Barrier spraying It was observed during trial in the Fourteenth Army (Afridi) that spraying of a site and a belt of 50 yards round it including building, on the inside and the outside and every feature in the terrain with 5 per cent DDT in kerosene 01 at the rate of 5 gallons per acre pre vented o per cent of prevailing mosquitoes from infiltrating into the protected zone Spraying of a so feet belt only round a camp site was not so effective as in the case where camp site itself was sprayed Area and zone spraying re quires repeated spraying after 10 days and therefore this method can be used only of the stay in a place is of short duration Residual spraying should be started in and around the buildings one month before transmiss on of malaria is due to commence and repeated monthly throughout the malaria season If it is found that the infective mosquito rests on the exterior of the building after taking its blood feed the exterior of the building should also be sprayed The spray ing should be done so as to deposit effectively DDT crystals in the required strength on all the surfaces where the mos. quitoes are likely to rest It is done effectively with the Four Oaks pattern knapsack sprayer or stirrup pump with special nazzle The minimum dosage of solution which can be applied evenly from distance of one foot from the wall in the case of Four Oaks sprayer is one quart per 250 sq ft The sarrup pump with the same quantity can spray up to 500 sq feet By increasing the distance of the nozzle from the wall the dosage of solution can be decreased Although the sturup pump requires two persons to operate and its rubber tubings sometimes burst during spraying at can effectively spray with a speed of 4 feet per second without contaminat ing the clothes of the operator to a considerable degree A few precautions are essential during spraying No food cooling utensils etc should be allowed to be contaminated with ODT The persons employed to spray should use pro tective ez e shtelds gloves and overalls whủe spraying and should have a bath wath soap and hot water after spraying Other Insechcides A lot of experimental work has ·64 INTRODUCTION TO MALARIA PROBLEM IN INDIA been done lately to alter DDT molecule and also to change the number of chlorine atoms in DDT molecules to substitute other chemical groups such as Flouro, Bromo and Methoxy A number of solvents and emulsifiers have been used DDD DFDT, DMDT and the like are less toxic to human beings and insects DDD has almost the same or better action than DDT on larvæ but is less toxic to adult mosquitoes By completely altering the structure powerful insecticides like benzene hexachloride chlordane or octa chlor, toxaphene or chlorinated camphene and parathon have been produced Imperial Chemical Industries Ltd has introduced Gammexane which contains the gamma isomer of benzene hexachloride 65 per cent of this isomer is present in Gammexane powder P520 Ross Institute of Tropical Hygiene recommend a single dose of 10 mg gamma benzene hexachloride per square foot to obtain control of adult anopheles for a period of at least three months Twelve ounces of Gammexane P520 mixed with one gallon of water and dispersed at the rate of half a gallon per 1000 sq ft give a deposit of about II mg gamma BHC (gamma iso mer) per square foot Chlordane has been widely used with success in Italy against house flies Toxaphene has the same residual toxicity as benzene hexachloride and chlordane High toxic effect is also claimed for 497 and 118 but sufficient data are not yet available to give any definite opinion Hera ethyl tetraphosphate tetraethyl pyrophosphate and diethyl nitro phenyl thiophosphate (parathion) are other insecti cides belonging to phosphate series It however has not prolonged residual effect but is effective against immature stages of insects In the phosphate series parathion is the most important Synergists Work is also being carried out on synergists for DDT Synergists can be put in two categories viz those affecting physical properties of the residual deposit and those which are toxic in themselves Gum rosin 10% is often used Gum rosin acts as nucler for DDT crystals They not only tend ·ANTI MOSQUITO MEASURES 65 to increase the toxicity of the DDT but the adhesive pro perty of gum rosin prolongs their residual action The common examples of toxic complementary synergist are of pyrethrum and DDT methoxychlor and DDT and chlor dane and DDT It may be emphasised that the use of modern insecti cides like DDT as a residual spray has proved that it is the most effective and practical method of controlling malaria especially in rural areas It is obviously necessary to organise and plan the spraying after carefully considering the ecology of the local mosquitoes especially the local vector and investigating local conditions Love call trap Reference may be made to an interesting experiment carried out by Kahn et al (1945) They have found that mosquitoes make various sounds while flying and by beating wings or rubbing tarsi again t wings These sounds include a love call On hearing the love call (audible and inaudible to human ear) of a single female mosquito numerous male mosquitoes turn their an tennæ and hypopygium towards the female and burst into a chorus Work is being continued to produce the love call mechanically in DDT treated spots in the hope that all male mosquitoes within hearing distance will come into the trap and die This would avoid spraying of large areas with DDT Personal protection Personal protection from mosquito bites by suitable house construction use of nets uitable clothing and repellents are still some of the effec tive methods of preventing malaria infection House construction Screening of buildings in maları ous localities is of great value The following figures by Hanafin as early as 1928 showing the result of screening in British troop barracks in Lahore speak for themselves — Year Admission per 1000 Unscreened srreened barracks 1926 182 12 672 35 1927 45 61 265 98 The main objection to screening often put forward is that the atmosphere inside screened hou es is suffocating ·66 INTRODUCTION TO MALARIA PROBLEV IN INDIA and the rooms become dark Lack of light and ventilation is often noticeable in houses which were originally built on the usual popular plans, and of which the screening of doors and windows was done afterwards Covell (1941) recom mends that the following principles should be observed Building to be screened must be built and kept in good repair Door frames should be made of seasoned wood with iron brackets at the corner and should not sag on their hinge A double wire attached diagonally across the lower half of the door and tightened up with turn buckle will tend to prevent this No attempt at edge fitting should be made The door should be made to fit against a } batten all round the inside and sufficient space allowed for the door to swell in wet weather without scraping at the bottom A light strip of wood should be nailed across the door frame at about the height of a man s shoulders This is to push against when opening the door There should be two fastenings for each door one half way up the top section and one near the bottom The lower panel of the door may be strengthened by wire netting as a protection against hicks and against dogs attempting to enter or go out Doors should open outwards so that mosquitoes resting on them may, be driven out when they are opened They should be placed on the windward side of the house for the mosquitoes tend to congregate on the leeward side It is of great advantage to have double doors with a porch or vestibule at least 6 feet in length be tween them Strong springs should be fitted to the doors to ensure that they will remain tightly closed when not in Every aperture in the building should be screened No removable screens or shutters should be used No screening should be used within one foot of the floor because it is liable to be damaged when the floor is scrubbed No furniture should be placed against screening Putting wire gauze on existing doors and vindows affects the venhlation considerably Windows should be provided for the sento latron lost In Federated Malay States when mosquito proof houses are built and 16 mesh wire gauze used the window area is doubled to make up for the loss in ventilation caused by the gauze The gauze used in the barracks of use ·ANTI MOSQUITO VEASURES 67 Brush troops in India was 14 mesh and 28-30 SWG giving an aperture of 0 055 to 0 057* The venulation and light ing can be improved by electric hghts and fans and by designing the house especially for screening (screens are mainly put round the verandahs) For screening to be effective the persons living in it should not remain out of the house after sunset and before sunrise The estimated cost of a mosquito-proofing building in normal times is about 2 to 3 per cent of the total cost of building Temporary labour camps can be made mosquitoproof by the use of condemned mosquito nets on doors and windows Nets The mosquito netting with a mesh of 28 to 29 holes in a square inch and made of 30/40 cotton will keep mosquitoes out Nets should be preferably white rectangu lac in shape with netting also in the roof and no openings inside They should be set down before sunset The free border should be tucked in continuously all round the bed ding No portion of it should be allowed to flap about loosely When going to bed only the minimum portion of the net should be lifted to enter and then it should be care fully tucked in again under the bedding Nets should be turned inside out preferably daily and the pole corners searched for mosquitoes Protective clothing People should wear long sleeve shurts slacks or pyjanias or shaltars The dhoit does not give the necessary protection Mosquito boots or Welling ton boots are very useful In any case every atternpt should be made to so ciothe oneself that the minimum amount of body is laid bare for mosquitoes to bite Veus and gloves have been used in various armies for guards on duty Repellent Plain citronela oil apphed 3 hourly gives satisfactory results while naphthalene conc ext of pyre thrum cream gives almost the same results A non greasy vanishing cream can be made of gum tragacanth powder 2 parts oil citronella 2 parts pyrethrum 2 per cent 80 parts wates is added after mring all the ingredients The cream should be liberally applied at 2 hourly intervals on must the vector as it As am 16 meso 28 ISHG wag pertust of 048 inch 13 required Where A

·68
INTRODUCTION TO MALARIA PROBLEM IN INDIA
all exposed parts of the body Dimethy) phthalate and
dibutyl phthalate in liquid form are agreeable to use and
are very effective especially the former, even when a feu
drops are rubbed on exposed parts and have replaced the
creams used formerly Its effect lasts for about 4 hours
DMP fish nets Afridi et al (1945) report that
finch mesh nets (fish nets) and garments impregnated with
0 42 cc dimethyl pthalate give complete protection from
mosquito bites for 72 hours Nets treated again
conferred
protection for longer periods
REFERENCES
AFRIDI M AND ARTHUR J H (1945) South Africa Med ]
19, 361 365
COVELL G (1941) Balana Control by into mosquito measures
Thacker Spink and Co (1933) Ltd Calcutta
COVELL G (1947) Anh mosquito Measures Health Bulletin No II
Manager Publication Della
KAHN MC CELESTIN W AND OFFENHAUSER W (1945) Science
March 30 335-6

·CHAPTER VI MALARIA SURVEY & ANTI MALARIA CAMPAIGY It will be obvious from the foregoing account that before starting an antimalaria campaign in an area it is essential to carry out a preliminary survey The survey should include the study of physiographical features meteorological records mortality and morbidity by age groups directly or indirectly due to malaria total death and birth rates by age groups in different parts of the year spleen rate* and parasste rate amongst the children of the locality (chifdren between two and ten years are most suit able for the purpose) seasonal prevalence of malaria species of anopheline their breeding places flora and fauna of the breeding places bionomics of the mosquitoes and lovestigations regarding the carrier species Dissection of gland and gut of mosquitoes with a view to determine the infection rate and further investigations in detail regard ing the bronomics of the local mosquitoes especially the vector species will have to be continued as a preliminary survey Study of social and economic condition of the people and industrial and agncultural problems should not be overlooked After deciding the measures to be adopted in a locality it will be necessary to plan a scheme incorporating perma nent and temporary measures and undertake further in estiganions of the antimalaria problems of the locality In practice it is useful to divide large areas into small self contained usssts It is the smal unts which carry out the most important work in the field and are responsible for control measures in a locality Under a usit scherne the area of mafana control should include areas 1 to 1 mile beyond the periphery of a locality to be protected The Intectuat with malanz gwres Tsse to enlargement of plets The area come art classified usually as follows Over 30 spleen tate hyperend mucity. 25 50 ga endemscsty 10-35 low or moderate cadernicity 10 healthy Altes ro years of age immunity starts sad by about years of age splees may become Rortugal Spleeg rate therefore 1x co Idren between 210 years ·70 INTRODUCTION TO MALARIA PROBLEM IN INDIA whole area is duided into sub areas under a malaria inspec tor Each sub area may be further divided into six zones The work is so arranged that a field squad works in one zone at a time in rotation so that each such zone is thoroughly treated at least once a week It is necessary to keep records of the work done The following diaries are suggested * (1) METEOROLOGICAL RECORD Year Month Rainfall Date Maximum Vinimum Teroperatore Temperature Prevailing ஈம Relative humidity Noming Evening (Records must be made at specified fixed times daily Records of sub soil water may also be kept if possible) (2) MOSQUITO CATCHES Date Nonth Year Spectes Number Cattle Houses Namber from Precipittin Dissechos sheds each test Gland Gul Mosquito catching station 1 2 3 4 Various traps have been recommended for catching mosquitoes A type of trap used with success is a simple wire ring 2 feet in diameter over which a black or red cloth skirt is stitched with purse string at both ends These are hung two feet from the ground Dark red colour appears to attract mosquitoes In an experiment carried out with red and black traps 1147 mosquitoes tool shelter in red traps and 772 mosquitoes in black traps (Raina With regard to details of malaria soney reference should be made to Health Bulletin No 14 Valana Bureau No 6 How to do Malana Survey ·LUS MALARIA SURVEY 71 ONE OF THE MALARIA SURVEY AND CONTROL CHARTS IT POU 90 EVE M A u BALDAITESTET YOU ws Auto Mt by dharth Mole we Low 40 dy CEICA ARTI c D sel ht 00 20 0 DDO1001 The chart shows parasite add spleev rates in the narroandag villages nod arca adder control the species of 800 larvæ marked wbere they are found breeding area under control divided a six zones ABCDEF and the days on which they are viated by malarsa-control altra asd table showing the dumber of foalar3 cases weekly from each one 1943), A red earthensare chatts as almost as good Traps when used are put in corners of rooms in the catching sta tons In actual practice a well trained insect collector can 6 ·72 INTRODUCTION TO MALARIA PROBLEM IN INDIA catch more mosquitoes than the traps and most of the field workers have practically given up using traps Such catches can be of value only if the time duration and technique of catching mosquitoes are uniform Usually a large number of catches in a day indicate breeding places nearby for which search can be made For special investi gation further information can be added in the same diary catches during the first second third and fourth quarters of night etc VIZ 3 LARVAE Year Month Dato Flora vege Quality of water Fauna Place Type of breeding place Species tation (Labelled specimens should be brought to the Anti malaria Officer for inspection and verification) 4 INCIDENCE OF MALARIA BY AREAS (Zones if possible) Year Month Date BT MT Mixed Sena? No No of Name Sex Age houses Sfo Trapho Gan Tropho Gm Tropho Gm BT **Beniga tertian MT = Malignant sub-tertian 0 Quartan Tropbo=Tropbozoites Gm Gametocytes 3 Spleen rate Parasite rate 5 EXPENDITURE 6 MEASURES EMPLOYED The above figures can be consolidated weekly and numbers shown from each zone or barrack lane or street ·MALARIA SURVEY 73 The data so collected can be put down on enlarged maps with different signs especially showing breeding places (permanent and temporary) mosquito catches etc Maps are of great value and show all the facts at a glance The secret of success lies in good planning sound supervi sion and ability of the orgamser to get the work done in the way it should be done CHOICE OF CONTROL MEASURES > Measures required for different places will vary Permanent measures (including biological) should be adopted wherever possible The former requires a large investment but saves recurrent expenditure except the cost of maintenance Certain general temporary measures will be always applicable It has been argued that antlarval measures are conducted in the field and consequently are easily supervised whereas success of anumosquito measure especially spraying is easier to organuse easily popularised and gives results in a very short time Both antlarval and antimosquito measures play an important part in most antimalaria schemes The fact that a judicious combina tion of antimosquito and antılarval measures gives best results is indisputable Antimosquito measures alone hase lately given promusing results The time to start ant larval measures is one month before the malaria season sets in and the antmosquito measures a fortnight before the onset of the malara season If funds do not permut to carry out this procedure antılarval measures should be started to begin with and a careful watch kept on the mosquto catches and incidence of malana Any rise in a zone in the figures of either or both is a warning that spray ing should be started without delay During the height of the na season or when malana incidence is expected to nise spraying to kill adult mosquitoes should be augmented During the non malanous season measures to kill adolt mosquitoes may be suspended in any antiarval scheme greatest attention must be paid to control species responsible for carrying malaria in a locality but other mosquito breed ing places including cuhcine should not be neglected

·74
INTRODUCTION TO MALARIA PROBLEM IN INDIA
Permanent measures including biological should be com
pleted before the malaria season sets in
REFERENCES
CHRISTOPHER SR SINTON JA and COVELL G (1941)
How to do Malana Survey Health Bulletin No 14 Malana
Bureau No 6 revised by COVELL G Manager of Publications
Delhi
RAINA BL (1943) Photo Bionomics of Josquitoes of hangra
Valley (not published)

·CHAPTER IN CHEMOTHERAPEUTIC AGENTS Intensive research pharmacological chemical and chmcal) to find a drug or drugs to ensure a radical cure of malana has been in progress for many years Cinchona and quinine held the field for a long time Sunce Paul Ehrlich in 1891 reported that methylene blue stains the malaria parasite and is likely to damage it mi estigations on synthetic drugs were started leading to the discovery of Plasmoquine by Schuleman and bus colleagues in 1924 Blutsche and Mauss carried on the work started by Schuleman and discovered synthetic schizonticide Ateban in 1930 and Bayers introduced it in the market in 1931 Similar drugs soon appeared in different countries Acriquinine in USSR Quinacrime in France Acridin xo in India Depacrine in England Since then a number of promising chemotherapeutic agents have been introduced Many of them are still in an experimental stage. Expers ments are being carried out on more scientific basis than before Not only the action of the drugs on different specses of parasites in their different phases (sporozoites pre and asexual erythrocytic forms and gametocytes) are investi gated but parasiticidal action on different strains of the same species is also observed QUININE 6 methovy a (s sunyl 2-quinucidyl) 4 quinoline methanol Quinine is an effective schizonticide It is cffective against asexual forms of all the parasites It has hardly any effect on the gametocytes of P falciparum buat destroys effectively gametocytes of Pusuar and slowly those of P malarc Quinine taken by mouth is httle absorbed m the stomach and passes through unchanged Hydrochloric acid of the gastric juice converts insoluble salts into soluble hydrochloride It is precipitated in the duodenum and absorbed as such Bile aids in its absorption Alkalies guen before auinne are reported to increase the diffusion ·76 INTRODUCTION TO MALARIA PROBLEY IN INDIA through the mucous membrane The quinine circulating in the blood (concentration usually I 250,000) is taken up by internal organs and split up and destroyed The te mainder is excreted by the kidneys excretion begins about 1 hour after taking the quinine and can be detected in urine by Mayer s reagent Salts requiring preliminary hydrolysis are absorbed slowly Opinions differ regarding the action of cinchona alhaloids Morgenroth observed that quinine forms a film on the surface of the red cells and prevents merozoites from entering the cells Hegner states that the site of action is intra corpuscular Bass assumes that quinine renders the cells permeable to blood plasma, so that parasites are destroyed by lysis Yorke and Macfie suggest that quinine hills some parasites by direct action while others are killed by the defence cells of the body activated by parasitised products (Field as quoted by Jogleker 1940) Taliaferro (1949) states that Quinine acts directly on the parasites and may kill them though their death is more commonly the effect of immunity pro Moulder (1950) suggests that quinine appears to exert its effects through preventing the formation of the postulated reactive 2-carbon particle) pyruvate oxidation in the early stages Seabra (1950) with an ultramicro scope observed that when blood and colloidal quinine solu tion placed together the quinine colloidal particles absorbed on the RBC the degree of absorption depended on the reaction of the blood If acid absorption was intense if alkaline it was feeble or absent The usual dose of quinine sulphate is gr vi to gry thrice daily by mouth giving a plasma concentration of 4 to 5 mgm per litre In children the dose is usually cal culated at 1 to it g plus half the age In severe cases with hyperpyrexia hyperparasitaemia or vomiting gr of quinine hydrochloride or bihydrochloride in 20 cc of 25% glucose solution intravenously given at the rate of 2 cc per minute or quimine hydrochloride gr X (prefer ably mixed with urethane) in 2 to 4 cc of distilled water intramuscularly is usually given The Malana Commission of the League of Nations re commended that the standard product of cinchona should cess ·CUEMOTHERAPEUTIC AGENTS 77 > 7 contain not less than 70 per cent of crystallizable alkalord of which at least 1/5 should be quinine Thus was included in the Bntsh Pharmacopoeia 1932 as totaquina which is as effective as quinine Acton (1920) Acton Cwajel and Dewy (1921) Prain (1924) Acton and Knowles (1924) Fletcher (1935) Berkely Hil (1926) and James (1927) reported on great value of cinchona febrifuge Hicks and Dewan Chand (1935) held the view that therapeutcally quinne and totaquine are of equal value Napier in 1945 made the interesung observation that the recent work has in no way questioned the efficiency of quinine and other cinchona alkaloida On the contrary it has confirmed all previous works regarding the antimalanal activity of these alkalous and more specially of the mixed alkalord prepara tions which some of the poorer malanous countries may on economic grounds still prove to be the drug of choice for the mass of populations It may also be added that Mac Gilchrist (1915) working u Calcutta showed that parasite clearance in BT obtamed with quicune in 4 7 daj 5 5 with cinchonine 5 with quinidine and 56 with cincbondine in MT infection the figures were 61 56 485 and 43 res pectively showing that sa BT quinine acts most rapidly while quinidine in UIT Lane quoting Cordes (1924) and Ciuca et al (1923) observed that in MT cinchonunc is less satisfactory than quinine and chiconidine was less effective than quinine or cinchona febringe respectively Workers of Medical Research Council of the United Kingdom Teport ed in 1926 that quimale and quinidine are equally effective Pranger and Filer (1949) have recently reported that cinchona alkaloids act synergistically with each other in blood induced infection in bird malaria They also observed that combination of cinchonidine and quimne pro duce more farourable results than quinne alone in blood induced infection of Prelcism and P gallinaceum The Toute of adminstration of quimne has been subject of great controversy particularly the intramusculas injection Alkaloid snjected intramuscularly causes tissue necrosis which may into se nenes and blood vessels ir some cases abscess formation occurs and mlection with tetanus is possible (if proper aseptic precautions are no ·78 INTRODUCTION TO MALARIA PROBLEM IN INDIA taken) Clayton (Lane as quoted by Joglekar loc 66 remarks that giving an intramuscular injection is to push into a patient with a hypodermic syringe a lasting conviction that if it has come to a choice between bitter taste and bitterly painful experience it is better to take quinine by the mouth after all In case of intravenous injection action is rapid (90% passes from cur culation within a minute of lajection) and without pain Toxic symptoms are rare if the injection is given slowly Although many of the synthetic antunalarials have been found effective against acute attacks opinions regard ing the prompt use of intravenous quinine in emergency cases like those of cerebral malaria are unanimous (Covell 1919 Black 1949) ATEBRIN (MEPACRINE QUINACRINE) 6 chloro 9 (4 diethyl amino i methylbutylamino) 2 methoxy acridine Its action is more or less like quinine It is a poly valent schizonticide Its effect is more prolonged than that of quinine It does not destroy the gametocytes of P falciparum It is extensively localısed in the tissues and slowly released Large loading dose is therefore necessary to build plasma concentration Headache restlessness and gastro intestinal disturbances may be noticed Yellow staining of the skin may be seen but is transient The Intral loading dose for effective clinical cure varies from o 6g tolog The dosage commonly used is given below Ist day 2nd day Succeeding five days For partially immune 038 038 For non immune 108 038 03 g ог 098 or 06 g Ot" 06 g 06 g PLASMOQUINE (PAMAQUIN) AND OTHER 8-AMINOQUINOLINES The action of the plasmoquine group of drugs on schizonts of P vivax and P malarae is considered inferior to quinine and has hardly any effect on schizonts of f ·CHEMOTHERAPEUTIC AGENTS 79 Pfalciparum On the other hand it is a polyvalent gametocide especially a powerful gametocide for P falciparum It was known as early as 1928 that relapse rate of P Vivax under quinine plasmoquine treatment can be reduced herein lies its special advantage It is relatively a toxic drug Cynosis due to the formation of methaemoglobin haemoglobinuria abdominal pain and vomiting have been often observed and its routine use 1$ not recommended Pentaquint and Isopenta quine in the order stated are less toxic than pama quin The dosage usually recommended is o 06 g penta quine base daily with 20 g quinine sulphate for fourteen days Pentaquine monophosphate contains 75% of the base The patient should be under hospital observation when taking these drugs for obvious reasons CHLOROQUINE DISPHOSPHATE AND RELATED 4 AMINO QUINOLINES Chloroquine reheves acute attacks of malaria and is a powerful suppressive drug against falciparum infection Partially immune have been reported to be cured by a single dose of 0 58 Like mepacrine plasma concentration is built up slowly unless initial loading dose is given It is very active against all asexual erythrocytic forms Generally clinical cure is obtained in two to four days as against a week with mepacrine treatment None of the other 4 aminoquinolines (santochine oxychloroquine etc ) appear to be superior to chloroquine The dosage used in the USA and Venezuela is as follows Ist day Succeeding days USA 05 g divided two for three days doses 108 in Venezuela 158 15 g divided in three divided in three doses doses on second day only Camoquin also has been favourably reported ·So INTRODUCTION TO BALARIA PROBLEBI IN INDIA PROGUANIL (PALUDRINE) Ni puchlorophenyi N isopropyl diguanide It is a powerful schizonticide in benign tertian and malignant tertian malaria Malignant tertian infection can thus be completely cured It is believed to be the only antimalaria) which in non toxic dosage is a true casual prophylactic against malignant tertian infection There is wide margin of safety between toxic and therapeutic dose Paludrine monohydrochloride contains 86 5% of paludrine base The usual dose for adults of Paludnine IS 03 g once or twice daily for five to ten davs Slight toxic effects like vomiting and renal irritation have been observed But the toxic symptom disappears on the reduction of dosage or if the drug is stopped for a day or two It has been recently reported from Africa that attacks of fever resulting from Rhodesian strain of P falas parunt were not controlled for three or four days after palu drine therapy and attacks of malignant malaria were reported amongst persons who were under paludrine suppressive treatment Consensus of opinion however is that paludrne is still the drug of choice and in case of strains like the African mentioned above paludnine mono hydrochloride should be reinforced with mepacrine or chloroquine It may be added that the action of paludrine is less rapid than quinine mepacrine and chloroquine especially in P vivaz infection In emergencies therefore its use alone is unsuitable M 5943 (N 14 dichloro phenyl Ns isopropyl diguanide) is reported to be more active than paludrine and clinical trails are in progress Sulphonamides have been referred to as effective in P knoue lest in Rhesus monkey (Coggshell 1938) and S diazine S merazine and S thiazole as suppressive in P gallınaceum infection in fowls S diazine S merazine and S methazine are stated to be most promising in human malaria especially in P falaparum (Corel 1943) Investigations done at the Valana Institute of India showed that the following drugs have no effect on malaria Alstonia scholans A Gad Antique Quine Chirasal Coffee Husk Degan s remedy Fraxine malacophylla Hindscout HT7 Jwaraghna Saptaparna karanjiwa ·CHENOTHERAPEUTIC AGENTS SI ex seeds Lichtenstein cure malarıdol Sunine Tinospora cordifolia Vitex peduncularis It will be seen from the above that quinine mepacre chloroquine and allied 4 aminoqumolines and proguanıl are effective in the treatment of the clinical attacks of malana Chloroquine and proguanil are at present the drugs of choice In relapsing viax malana concurrent treatment with quinine and B-aminoquinoline such as isopentaquine may be preferable SUPPRESSIVE TREATMENT It is generally agreed that the follosing drugs will effectively suppress malaria Mepacrine Non immiune The daily dose to hydrochloride 01 g daily (pre be continued in ferably with build case of falciparum up of a3 & daily for at least three for 5 days) weeks after Partially immune posure 028 twice weekly or 03 8 weekly may be useful for mass prophylaxis where the inten sity of malana is not very high 018 daily is most satisfactory Chloroquine 025 toos g base once weebly on the Sanne day of the Meel Proguan: 036 once a wech hyperendemic are25 In other areas o Ig to o 3 8 weekly base gis en promising results ·POSTSCRIPT The happiness and prosperity of the people are closely connected with the degree of the health which they enjoy Varied aspects of public health problems are intimately related to the social and economic conditions of the people the availability of trained personnel material and equipment, the extent of the country s capacity, a co-ordinative machinery and adequate control to ensure carrying out of plans experiments and research India despite its rich natural resources is a very poor country poor in goods poor in education poor in health The per capita income in 1939-40 was Rs 671 per year During 1946 47 it was Rs 228)- On such a low income people have to eat, clothe themselves and live In pre war days the cost of the cheapest balanced diet alone was Rs 48/- to Rs 72/- per head per year The cost of living has considerably increased since * Education is poor about 88 per cent of the people being illiterate Health education is poorer still Doctors and nurses are limited Only about one doctor to 6000 and one nurse to 43 000 are available Tacilities for specialist training and research are patchy Coupled with such an unfortunate economic and educational background the standard of public health is one of the lowest in the world Famines and epidemics are not infrequent The following figures for 1937 quoted by Grant (1944) tell a tragic „tory Expectation of life Death rate per 100 Infant mortality per 1000 births Australia England & Wales Japan Undivided India 67 years 63 +7 27 94 124 170 224 37 58 106 162 The Index number of wholesale pnces in March 1950 was approxi mately as follows ·PROGRESS MADE 87 In India amongst the preventabic diseases malana claims first place in importance It is doubly unfortunate that to a great extent malana is the creation of man The responsibihty for public health adminstration fres mostly on Provincial nos State Governments But the control of the State Governments over local bodies is so weak that not much progress has been made The report of the Simon Comnussion (1930) is worth repetition The result of the legislative and administrative action takes in accordance with the scheme of the reforms was in effect to deprive the new Ministers of local self govern ments of powers which were essential of they were to perform their task successfully As to the urban population the report of the second meeting of the Central Advisory Board of Health 1939 recorded that According to available information nearly half the districts and three quarters of the municipalities 15 British India are still without guahfied health officers many of the areas visited by us we have been unfavourably impressed with the standard of health administration and with the manner in wluch these duties have been perform ed Health Officers are to be found in most of the larger municipalities but their work is too often ineffective because they have incomplete control of the health organi sation or because their recommendations fail to receive active consideration from their councils A few munici palities and corporations uke Bombay are notable exceptons It is obvious that scientfic preventive and curative services are still beyond the reach of Bo per cent of the men women and children of India Progress has been made in the last few years but it has been patchy and Imted to zsolated areas Taking India as a whole the menace of malaria is no less than it was before as is evident from a) India mortality and morbidity figures With the brief account set out in previous sections in mind one is forced to the conclusion that the malaria problem cannot (Base yeas cadug August 1939-100) General index Food articles Certals 3924 396 2 +340 4406 7 ·88 INTRODUCTION TO MALARIA PROBLEM IN INDIA be adequately solved without the solution of economic educational and other vital problems referred to above The message of health can be brought home to the people not by preaching alone but also by providing facilities to put into practice what they are taught It is futile to ask a poor farmer to use mosquito nets or canvas mosquito boots so long as he cannot afford more than a loin-cloth and at least a pair of old sandals (chappals)--the latter usually to be kept tied at the end of the stick resting on his shoulder to prevent wear and tear and used only when absolutely necessary while walking on hot sand or thorny ground A malarıologist obviously cannot plough his soli tary furrow He has to take the help of the economist the educationist the agriculturist the engineer the lawyer and the State Consideration of vast and varied problems is essential for the study of the health problem of a country in its true perspective It must be emphasised that large tracts of land can be brought under cultvation if malaria problem is solved The solution of the malaria problem in India requires the serious consideration of five principal factors viz (1) education (2) organtsation (3) medical protection ta) legislation and (5) funds (1) EDUCATION (a) Health education must form a part of general education and should be appropriate for the age of the child (b) The sanitary conscience of the public should be awahened by intensive and extensive propa ganda Propaganda by means of leaflets pamphlets, posuers exhibition films etc has its own utility but unaided by practical demonstration it hardly serves its purpose as most of the people do not comprehend what exactly the leaflet contains or the poster denotes For propaganda to become successful practical demonstrations are essential Medical men can form an All India Antimalana Association Such an Association can play a very effective role ·PROGRESS VADE 8g (c) Malarsa should be introduced as a special subject in all the medical schools and colleges of India A chair for teaching malariology should be in troduced in the universities Even if only one question on malaria is asked in an examination paper of Hygiene and Public Health it will sta mulate the interest of medical students in mula nology Facilities for field work and research work should be as aulable for the post graduates in all untersitses Refresher courses for already qualified medical personnel wilt prove of great value A large number of medical men engineers malaria assistants and inspectors will be required Every registered medical practa toner can be hept informed on current ideas concerning malana control through circulars by a Central Health Organization (2) ORGANIZITION Malaria control should be centralised and not left entrely to the local bodies A scheme more or less on the following lines can ensure efficiency and unfortuity (a) Central Board of Jalania Control The rest bers of the Board can be selected by the Central Advisory Board of Health and should include amongst others a Consultant in malariology There should be a Drector of Malaria Control in India who can work as Secretary to the Central Board and through him the Board can exercise executive control over the States The Board can draw out a 15 y car plan in collabora tron with the World Health Organisation for dealing with the menace of malaria and should ensure that it is carried out (u) State Governments should have a Deputy Director of Malaria who will be directly res ponsible through the Director of Public Health to the Director of Nalana Control India The State Governments should have a State Malaria Control Board which should include the Minus ter of Public Health the Director of Public ·90 INTRODUCTION TO MALARIA PROBLEM IN INDIA Health the Chief Engineer, Directors of Agn culture Fisheries Botanical Gardens the Finance Minister and Conservator of Forests Representatives of Zamindars Industries Rail ways and Municipalities can be co-opted The Deputy Director Malaria Control, can act as Secretary (c) Districts or a group of districts should have an Assistant Director Malaria Control with a mobile field laboratory consisting among others an entomologist When the preliminary sur veys are completed the field laboratones may be kept only in one or two districts in the State (except those which are non malarıous) Every district should have an antimalaria committee more or less on the same lines as State Com mittees A detailed health survey including an entomological survey of the whole of the inhabited parts of India is essential This should be started in hyperendemic malarious areas first All constructions of roads canals factories and residential buildings ought to be approved by a malanologist (d) In every sub-division endemic or hyperendemic districts or in Tehsiis there should be an antı malaria officer and an antimalaria committee Staff for malana control will obviously not be necessary in malaria free areas It may be stated that some States have already started Malana Control Organisations (3) MEDICAL PROTECTION For the treatment of 100 to 200 million sufferers from malaria qualified medical men hospital accommodation nursing facilities and necessary quantities of quinine and synthetic drugs are required It was esumated that there were only 47.500 doctors and 7 000 nurses in United India and if one doctor for 2 000 of population is necessary India will require 185 000 doctors Adequate planning for the production of drugs like quinine and proguanil is essential ·PROGRESS MADE JI It is estimated that the quantity of quinine required for India is about 15 mllion pounds The quantity consumed in pre war years was about 2ro ooo pounds out of wluch only about 70 000 pounds was manufactured in India Parts of Assam Bengal Orissa Bhutan Sikkim Madras Travancore Cochin Mysore and Coorg are suitable for anchona cultivation It is reported that 38 000 acres of land (each acre capable of producing too to 200 pounds of quinine per year) are available in India It will be observed from the above figures that India can not only become self supporting for its quinine but can produce ten tunes its requirements (hnshnan 1940) The recently discovered chemotherapeutic agents have now to a great extent re placed qumine Their manufacture in the country will reguire change in cinchona cultivation policy There is no reason why chemical and pharmaceutical works should not be able to produce drugs for India s need In view of their therapeutic value we must now work out carefully our requirement for malaria control stores equipment and drugs and plan their production in the country Production of quinine may be necessary for the tme being till the country starts producing the new chemotherapeutic agents in suffi cient quantsty to meet the total requirement Their distri bution will require considerable planning and can be done by the Central Malaria Control Board Apart from cura tve drugs large quantities of DDT suitable mixtures of ols paris green and pyrethrum etc will be required for malaria control Pyrethrum requires a high alttude with a dry clunate and sell drained soul and it is very encourag ing to find that it can be successfully cultivated in hulu Palampur hashmir and Nilgiris It is estimated that 15 000 short tons (2000 lbs for a ton) will be required for India s need per year This will require 120 000 acres of land to produce Once DDT and other new insecticides 18 sufficient quanuty become available in the country the cultivation of P3 titzt can be reduced or completely replaced by other crops Economic aspect of malaria con trol measures is vital With the assistance of the World Health Organisation supplies can be arranged for the one belog from abroad at reasonable cost ·92 INTRODUCTION TO MALARIA PROBLEM IN INDIA (4) LEGISLATION Discussing public health services the Supreme Court Justice John M Harlan observed that it is the settled doctrine of this court that as a Government is organised for the purpose among others of preserving the public health and public morals it cannot divest itself of the responsibi lity of providing these objects' Consolidated laws must be enacted and enforced to ensure that health rules laid down by the experts are carried out (5) FUNDS Local bodies have neither the resources nor the money to finance malaria control scheme on a large scale They may be able to meet only a small portion of the expenses the rest will have to be shared between the States and the Central Government The Central Malaria Control Organı sation should be allotted necessary funds and should have the powers to allot money to the States according to their respective requirements There is no doubt that in the beginning expenses will be high but every rupee spent will mean thousands of rupees saved together with the preservation of thousands of lives and the prevention of the untold miseries endured by malaria sufferers No price is too great for ensuring public health security The inter departmental committee to co ordinate health and welfare activities (a co ordination which is an essential part of any health programme) in the USA observed in their report It is the conviction of the Committee derived from experience that at the present time there is no greater public need from the standpoint of individual and social security than a mprehensive programme to safeguard a nation s health It is an observation which is true for any part of the world for 1939 REFERENCES GRANT J B (1944) Health of India Oxford University Press Bombay KRISHNAN V (1910) Bengal Public Health Journal 2, I ·APPENDIX 1 MALARIA INTRODUCTION I Malana is by far the most important disease in India from the point of view of sickness and mortality Lieut Colonel J A Sinton a malanologist of international reputation and a former Director of the Malana Institute of India has estimated that at least 100 million persons suffer from the disease every year in Bnush India that because of its effect in lowering the vitality of its victims it is also responsible for morbidity from other causes in an additional 25 to 75 million persons annually and that directly and indirectly it is responsible for at least two million deaths each year 2 It is impossible to make any complete or accurate evalua tion of all the losses for which malana is responsible For instance at is difficult to assess the financial loss that the country suffers as the result of decreased productivity through the incidence of the disease Col Sinton has however estimated that on an admit tedly incomplete but conservative basis the annual loss to the country measured in terms of money may be anywhere between Rs 147 crores and Rs 187 crores per year If all the relevant factors could be taken into consideration the loss is Likely to be two or three times this estimate 3 A tragic feature of the situation is that much of the malaria prevalent in the populated areas of the country is man made In many case roads and railways have a sını ter account to their credit Their embankments often cause such interference with natural dra nage as to create conditions favourable to the breeding of the malana-carrying types of mosquitoes while borrow pits which follow the line of our roads and railways help to provide additional breeding grounds Bengal is generally cited as an out standing example of mans thoughtless interference with natural drainage resulting in the steady nse in the incidence of malana over the greater part of that province The failure of imgation engineers to provide for adequate drainage when water is brought into pre viously dry areas has been another fruitful cause of the spread of the disease Recent examples of this are to be found in certain areas in Sind the Province of Madras and Mysore The first question with wh ch We are faced is whether the great drain on the national health and prosperity caused by malaria is unavoid able After the discovery by Sir Ronald Ross towards the close Extracts from the Report of the Health Survey & Development formattee 1946 Vanager of Publi abone Delhi ·94 INTRODUCTION TO MALARIA PROBLEM IN INDIA of the last century that certain types of mosquitoes are the trans mitters of malana it has been demonstrated in limited areas in different parts of the world that the stact enforcement of anti mosquito measures can effectively control the incidence of the disease In the Panama Canal Zone the first attempt to construct the Canal was frustrated by the ravages among the workmen of two mosquito-borne diseases yellow fever and malana When however radical antimosquito measures were enforced in this area these diseases were brought under complete control The introduction of effective antimalana measures at Ismailia in the Suez Canal area and in Algeria was attended by equally convinc ing results In this country the Raipur Vizagapatam section of the BN Railway could not have been constructed had not malaria among the labour force been kept under control by an expert malanologist while the Mettur dan and the Sarda Cana! afford other instances where large imngation projects were success fully completed with the help of malana control measures In cent years even more effectiv preventive measures against malana have become avaylable including potent chemicals for the destruction of the mosquito and drugs for protecting man against repeated infection The remarkable manner in which the fighting forces of the Allies operating in highly malanous tracts have been protected agajast this scourge duning the present war again bears testimony to the possibility of effectively controlling the disease It is clear to us that gi en the determination the money and the requisite staff it should be possible to reduce the incidence of the disease in India to small proportions ANTI VALARIA MEASURES 4 The measures that are necessary against malana fall under two main heads namely (1) those which are directed against the transmitter of infection the mosquito and (2) those which deal with man in his twofold capacity as a victim of the disease and as a reservoir of infection Antimosquito measures may be grouped under the following heads those which control the breeding of the mosquito and (11) those which are directed against the insect in its adult forma 5 Jeasures to control the breeding of mosqutoes-- These measures take a wide variety of forms although the main princi ples involved are the same the obliteration of facilities for the laying of eggs by the female mosquito and the creation of conditions inimical to the survival of the insect in its larval stage In circumstances when egg laying cannot be prevented The steps that are necessary for these purposes include among others drainage to prevent accumulations of water canalisation of water channels and the removal of vegetation from their sides the use of larvicides such as mineral oils pans green and the more recent viz ·APPENDICES 95 synthetic product DDT selective clearag of jungle or shading of water courses in certain cases and the use of larvivorous fish 6 There are many vaneties of fish in this country which prey on mosquito larvae Gara busta an Amen can species of now introduced into India about twenty years ago as besog used in the wells in Bangalore and Bombay the onssamestal Waters in Delha and in many other parts of the country This species has been proved to possess all the qualities requared for am mosquito work and is probably more sustable for this purpose than any other species It should be emphasised however that the salue of fish is very limited They are useful in artificial collections of water kke ornamental waters but their use is of doubtful value as a general antilars al measure 7 For dealing with the malarial conditions created by large constructional works and urgation projects well planned schemes requiring considerable technical supervision and heavy expende ture will be necessary These can obviously be undertaken and carried out only by the State On the other hand sa many parts of the rural areas effective results may be secured by works of a minor nature such as the filling up of pools and ditches so as to prevent collections of water or other measures already men toned such as oring removal of vegetation etc Is Our short term programme we have made certain suggestions for the Carrying out of suck measures 19 rural areas We have provided for a small labour force of 15 in each primary unst one of whose dates will be to see to the carrying out of these minor works These men say be unable to deal effectively with the whole acea covered by such a unt but an important part of their work will be in their being able as a trained group to demonstrate to the villagers how to go about these tasks properly We hope that the village Committees we have recommended (vide Chapter IV) will be able to mobilise voluntary local effort in carrying out such measures and that we shall thus be able to eatst a tremendous force in the fight against this disease The small labour squad will also form the nucleus round whics during an epidemic an expanded organisation can be rapidly built up 8. It is desirable that the planning and execution of these antimalanai works should as far as possible recene technical guidance and we bave recommended the appointment of an Assist ast Public Realth Engmeer at the headquarters of each secondary uait for this purpose Direct local supervision will be provided by the medical officer in charge of the primary unit and lus two public health inspectors 9. Although we hope that the local eitort se bave referred to will belp to reduce the cost of laboar suficient public funds should be made ayudable to ensure that the required expenditure will be fully met We have included in our budget for each ptunar ook & provision for meeting thu expenditure ·94 INTRODUCTION TO MALARIA PROBLEMI IN INDIA of the last century that certain types of mosqutoes are the trans mitters of malana it has been demonstrated in limited areas in different parts of the world that the strict enforcement of anti mosquito measures can effectively control the incidence of the disease In the Panama Canal Zone the first attempt to construct the Canal was frustrated by the ravages among the workmen of two mosquito bome diseases yellow fever and malaria When however radical antimosquito measures were enforced in this area these diseases were brought under complete control The introduction of effective antimalaria measures at Ismailia in the Suez Canal area and in Algeria was attended by equally convinc ing results In this country the Raipur Vizagapatam section of the BN Railway could not have been constructed had not malana among the labour force been kept under control by an expert malanologist while the Mettur dam and the Sarda Canal afford other instances where large imngation projects were success fully completed with the help of malaria control measures In recent years even more effective preventive measures against malana have become available including potent chernicals for the destruction of the mosquito and drugs for protecting man against repeated infection The remarkable manner in which the fighting forces of the Allies operating in highly malanous tracts have been protected against this scourge during the present war again bears testimony to the possibility of effectively controlling the disease It is clear to us that given the determination the money and the requisite staff it should be possible to reduce the incidence of the disease in India to small proportions ANTIMALARIA MEASURES 4 The measures that are necessary against malana fall under two main heads namely (1) those which are directed against the transmitter of infection the mosqwto and (2) those which deal with man in his twofold capacity as a victim of the disease and as a reservoir of infection Antimosquito measures may be grouped under the following beads (i) those which control the breeding of the mosquito and (11) those which are directed against the insect in its adult fom 5 Measures to control the breeding of mosquitoes--These measures take a wide variety of forms although the main princt ples lavolved are the same viz the obliteration of facilities for the laying of eggs by the female mosquito and the creation of conditions inimical to the survival of the insect in its larval stage in circumstances when egg laying cannot be presented the steps that are necessary for these purposes include among others drainage to prevent accumulations of water canalisation of water channels and the removal of vegetation from their sides the use of larvicides such as mineral oils pans green and the more recent ·APPENDICES 93 synthetic product DDT selective cleaning of jungle or shading of water courses in certain cases and the use of larvivorous fish 6 There are mady vaneties of fish in this country which prey on mosquto larvae Gambusia an Anencan species of muanow introduced into India about twenty years ago is being exscd in the wells in Bangalore and Bombay the ornamental waters La Delht and in many other parts of the country This species has been proved to possess all the qualities required for anti mosquito work and is probably more suitable for this purpose than any other species It should be emphasised however that the value of fish is very limited They are usefal in artificial collections of water like amamental waters but their use is doubtful value as a general antılarral measure Far dealing with the malanal condstons created by large constructional works and smgation projects well planned schemes requinng considerable technical supervision and heavy expendi ture will be necessary These can obviously be undertaken and carried out only by the State On the other hand in many parts of the rural areas effecuve results may be secured by works of a menor nature such as the filog ap of pools and datches so as to prevent collections of water or other measures already men toned such as oiling rencaval of vegetation etc 18 Our short term programme we have made certais suggestons for the carrying out of such measures in rural areas We have provided for å salt labour force of is w each primary unit one of whose duties will be to see to the carrying out of these minor works These men may be unable to deal effectively with the whole area covered by such a unt but an important part of their work will le in their being able as a trained group to demonstrate to the villagers how to go about these tasks properly We tape that the village Committees we have recommended (vide Chapter IV) will be able to mobilise voluntary local effort in carrying out such measures and that we shall thus be able to enhst a tremendous force in the fight against this disease The sisall labour squad will also form the nucleus round which dunng an epidemicas expanded organisation can be rapidly built up 8 It is desirable that the planning and executon of these antimalarial works should as far as possible recente technical guidance and we have recommended the appointment of an Assist ant Public Health Engineer at the headquarters of each secondary ait for this purpose Direct local superviston we be provided by the medical officer in charge of the primary unit and his two public health inspectors 9. Although we hope that the local effort we have referred to will help to reduce the cost of labour suffcrent public funds should be made available to ensure that the required expenditure will be folly met. We have included in our budget for each primary last a Provision for meeting this expenditure ·98 INTRODUCTION TO MALARIA PROBLEV IN INDIA circunstances a course of plasmoquine treatment following medi cation for cunng an attack should be advocated as tending to reduce the chance of infection being conveyed to mosquitoes ANTI MALARIA ORGANISATIONS AT THE CENTRE AND IN THE PROVINCES 16 In an article entitled The publtc health aspect of malana control in the Indian Medical Gazette of December 1942 Major-General G Covell MS Director Malana Institute of India made the following observations An essential preliminary to the successful control of malana in India is the formation of an adequately staffed permanent malana organisation in each province the activities of which should be linked up with those of the central organisation of the Government of India 17 We fully endorse this view One of the great defects of the anti malaria campaign in India during the past 50 years was that it consisted of a series of spasmodic attempts to control the disease This lack of continuity of effort accompanied as it often was by the employment of an organisation with insufficient staff and equipment has been largely responsible for the inadequacy of the results achueved As we have already said it has been amply demonstrated dunng the present War that with adequate measures even the highly malarious regions of the Tropics can be rendered comparatively safe from this disease Again we have pointed out in our review of existing conditions how the malana organisation which has been working in the Delhi urban area for the past seven or eight years has shown that under civil conditions also a reasonably effective control of the incidence of the disease can be achieved provided adequate funds are expended under the best available technical advice In these circumstances we feel that there can be no excuse for Governmeats in this country not attempting to organise an effective campaign against the disease Its wide prevalence the cost involy ed and the existing inadequacy of trained personnel may result in this cam paign being extended over perhaps many years Even so it is most important that a beginning should be made and in the following paragraphs specific proposals are made towards this end 18 Central Malana Organisation The Malana Institute of India is the central organisation for advising the Government of India on all matters relating to this disease as well as for assisting Provincial Goverinents with such technical advice as they may require Its functions have been defined by the Director of Malana Institute in the followzag terins I To be fully informed upon all malaria problem Το advise Government on all issues relative to malana in India ·APPENDICES 99 2 To zatate enquiries and investigations on malana To carry out such qunes as Government may for any reason sequre To assist provincal organusa tions in the carrying out of such inquines as may be under taken by them providing such assistance as desired and even in certain cases when thought accessary to lend officers temporanly from the staff to work under local government 3 To undertake systemanc research in due course into all the basic facts underlying malanta transmission prevalence and prevention such as the study of mosquitoes systematic and bronomica? types of malana parasites transmission power of different spectes of Asopheles mechanısını of infection including the study of endemic and epidemic phenomena etc Gradually to complete and organise knowledge on these subjects and to arrange for the making of such knowledge available for practical application of such other uses as may be desirable 4 To carry out epidemiological mvesugationsmapping of enderarcity study of hyperendemic and healthy areas study of malaria statistics on modern liges_and generally to elucidate the underlyrag principles of malana prevalence u India 5 To advise upon and assist in the carrying out of ant malana measures To study these scientifically and to judge and elucidate their results 6 To undertake clirucal work on malana including treat ment To study serum reactions and allied aids to diagnosis and understanding the disease To study relapse problems effects of new drugs etc 7 To assist affiliated researches {e g kalaazar filariasis sandly fever dengue Stegomya work) by sdentifica tion of matena! provision of trained staff and subords nate personnel 8 To teach and train officers and others in practical palana work 9 To publish scientific results useful gudes bullebins etc 10 To keep alive interest 13 walana study and prevention and to see that such interest wbereser present is purse and assisted We are in full agreement with the Director that these should be the main function of the Malana Institute of ladia The permapent esta bustment of the Institute consists of a Director an Assistant Director an Entomologist an Assistant to the Director & Malana Assistant and appropnate subordinate staff The new posts of a Deputy Director an Assistant ·100 INTRODUCTION TO MAI ARIA PROBLEM IN INDIA and of certain subordinate staff which were recently created as a temporary measure for the duration of the war should be made permanent In view of the large developments that are likely to take place in the activities of this malaria organisation the Central Health Department should bear in mind the importance of ensur ing that it is adequately staffed 19 The prolincial malana organisation. The general plan should be the creation of an organisation at the headquarters of each province and in addition a number of malana control units to operate in malarious areas in the districts The number of these units will obviously depend upon the size of the province and the extent and degree of the prevalence of malaria in it As an illustration we may set out a plan for the province of Bengal We think that about 150 such units will eventually be required for that province but a beginning may be made with ten Others can be added as and when additional trained staff and funds bc come available But it essential that even from the beginning suitable transport should be provided for these control units in order to increase their mobility and effectiveness In the larger provinces it will be necessary to provide regional organisations also in order to ensure that adequate supervision is exercised over the peripheral malaria control units In the smaller provinces however such regional organisations may not be neces sary Here the Provincial Malana Officers and their staff should be able to carry out the necessary supervision This Provincial Officer should have the status of an Assistant Director of Health Services and the Regional Malaria Officers may be designated Deputy Malaria Officers The complete organisation for a large province such as Bengal may be developed on the following lines - 1 Provincial Headquarters Provincial Malana Officer Entomologist Sanitary Engineer 1 Overseers 4 Draftsman Antimalana Officer Antamalana Assistants Laboratory Assistants Insect Collectors Deputy Malana Officers 5 3 Malana Control Units Antimalana Assistant Laboratory Assistants Malaria Supervisors 5 Fitter Mistrz Field Workers 25 I 2 1 2 ·APPENDICES TOY Antunalanal field workers are sem skilled labourers and should not be considered as cooles Lists of sustable equspment for the malana organisation at the proviacsal headquarters and for the malana control units are gren in Appendix 14 of Volume III of the report These estimates of the malana organisation desirable for a province such as Bengal including staff and equipment were prepared for us by the Director of the Valaria Institute of India ile has suggested the following approximate number of malana control units for the different provinces MO of contro? 549113 IDO 60 150 Ma of control units 30 00 5 30 NWF Province Sund Ajmoer Merwara Baluchistan Delhi Povince Coorg Madras Bombay Bengal Vnited Provinces Pesab Bihar Onssa Central Provinces & Ветах Assam 750 60 100 50 5 S2 100 So He has stated that in calculating these requirements he took into account such factors in respect of each province as the area population number of districts number of villages and the degree of prevalence of malana as indicated by (a) statistics of malana mortality and (b) the percentage of fever cases on total cases treated at kosp tals and dispensanes In our view the most essential requirements are ade quately traced personnel an sufficient numbers and the drugs appliances and other equipment for carrying on effectively the campaign against the disease He would as a general rule de precate the spending of large sumas on the erection of elaborate buildings in the early stages of our programme for se beliese that such money as is likely to be available can at the begabung be much more effectuely used on staff and antimalarial measures 21 We once again feel it necessary to stress the inestimable value of good rural communications in increasing the effectiveness of all wealth and other workers eraployed on patron buiding tasks For details regarding the staff required Eor such as organrsatsoo reference may be made to Appendix 14 The total expenditure isvolved in the development of malara argintsations in such as Appendur {ar ·104 INTRODUCTION TO MALARIA PROBLEM IN INDIA 28 We wish to make it clear that these recommendation of ours for concentrating the training of the higher type of malana personnel at Delhi are of a purely temporary nature When the antimalana organisations in the provinces become fulldeveloped the provision of training facilities for all types of malan workers should in our view be the responsibility of Provincia Governments We have suggested later in this chapter the crea tion of Chairs of Malanology in selected medical colleges in order to provide facilities for undergraduate and postgraduate trainin_ in the subject as well as for stimulating research Thus the pro vinces should in due course develop facilities for the highest typ of training that may be required in Malariology QUININE AND OTHER DRUGS FOR THE TREATMENT OF MALARIA 29 We have already 'referred to the use of quinine and mepacrine for the treatment of malana It is possible that othe_ drugs of greater therapeutic value may also be discovered as the result of scientific research It is therefore not easy to estimate accurately what levels of production in India should be recom mended for the immediate future in respect of qumine and mepa crine in order to ensure that proper treatment facilities are made available to a substantial proportion of the sufferers from malara All of us are however agreed that it should be the responsibility of Governments Central and Provincial to take a mutual con sultation such steps as are necessary to ensure the production in India of antimalana drugs in sufficient quantities to meet the requirements of the country within the shortest possible period We are equally agreed that the country should not again be placed at the mercy of a private monopoly which can control to its own advantage the price of these drugs which are essentral for the maintenance of the health of the people Whether in making adequate provision for these drugs Governments should them selves undertake extensive programmes of production or whether pnvate enterpnse can be relied on to supply the needs of the countrv through any system of guarantees or subsidies from the State are matters on which we are unable to express an opinion with the information at our disposal We can only lay down three general propositions - (1) the prices at which antimalana drugs are made available to the people should be sufficiently low to enable the poorest classes to obtain them in adequate amounts for the effective treatment of the disease (2) these drugs in whatever provinces they may be produced should be made available on an equitable basis and on reasonable terns for the needs of all parts of the country and ·APPENDICES 105 (3) no delay should be allowed to occur in dereloping their production We skall first consider the production of quiaine 30 (a) Quininen If Colonel Sinton s estimate that at least one hundred million individuals suffer from the disease every year be taken as the basis of calculation it does not seem unreasonable to assume that there will be at least 120 to 150 million cases to be treated annually in view of the fact that more than one attack is not an uncommon feature of the disease The Malaria Commissron has recommended 75 grains of quinine as the minimum quan tity necessary for the treatment of a case On this basis the amount of quinine required will be in the neighbourhood of 13 to 16 million pounds per year If quinine is to be relied upon as the sole drug for the treatment of malara our objective should be an annual production of it to the extent of about 15 million pounds from cinchona barb produced, in the country Some of us hold the view that this should be the definite objective which Governments should place before themselves and that every endeavour should be made to attain it within the shortest period that may be practicable Others feel that the experience gained during the War with the large scale use of mepacrine in the treat ment and prevention of malaria in highly endemic areas makes it Decessary to take into account the possibility of this drug replacing quinine to a greater or less extent in the treatment of the disease and that it would in the circumstances be safer to start with a more limited objective in regard to the production of quinine The average annual consumption of quinine in India in the pre war period was 210 000 lbs and of this amount about a third was produced in India a part of such production being we believe from bark imported from Java As a practical objective for realisation as early as possible those of us who hold this view Tecommend the raising of quinine production to the pre war level of consumption in India namely about 210 000 lbs from indı genous bark alone A cinchona plant begins to yield bark generally from the fifth year of its life the period of high produc tinty being from the fifth to the ninth year After the twelfth year its yield gradually decreases in these cucumstances the raising of the annual production of quinine even to 210 000 lbs mark from bark produced in the country will take some years In the meantime the possibility of synthetic drugs dispłacing qunite wholly or in part in the treatment of malana may well be settled Th 13 a question of considerab importance which should be decided before embarking on too ambitious a programme of quinine production Such a programme is certain to involve heavy financial commitments which would not be justified if it became possible to produce cheaper and equally effective synthetic substitutes 31 We as a committee would prefer to lease to the Govern ·106 INTRODUCTION TO BIALARIA PROBLEM IN INDIA ments in the country the responsibility for deciding whether pnvate enterprise should or should not be associated with the production of quinine and of other antimalana drugs If it is decided that such association is desirable it would be for Governments to deter mine the conditions under which prvate agencies should partici pate in production One of us (Sir Frederick James) however desires to see that prvate agencies are given the fullest opportunity to take part in quinine production with techtucal advice and a price guarantee provided by the State We attach our colleagues note on the subject We fully support his suggestion that research into the agncultural and manufacturing aspects of the quinine industry should be a governmental responsibility and that to expenmental stations should be established to serve North and South India respectively, 32 (6) Alepacrine-The pre war annual consumption figure of 210 000 lbs of quinine will pronde treatment at the rate of 75 grains per patient for about 19 6 or nearly 20 million cases of malaria If as an immediate objective, we accept the provision af adequate antimalana drugs for the treatment of 50 mullion cases annually then sufficient mepachine will have to be produced to meet the requirements of 30 million patients The muimum quanuty of this drug for a coraplete course for a patient is 15 grammes or x5 tablets of or gramme each The manufacture of 450 million tablets of mepachne a year an India should therefore be the immediate objective 33 Pyrethrum and DDT The main sources of pyrethrum before the War were Kenya and Japan but the cultivabon of the plant has been successfully undertaken in vanous parts of India including Kashmir the Punjab Hills the UP Central Provinces Madras and Orissa It has been shown that the yield of the active principle from the plants grown in many parts of India compares favourably with the flowers obtained from Kenya In these circumstances it may be reasonably expected that in the course of some years there will be an ample supply of Pytcthrum grown in this country to meet all ločal demands "The Director Malaria Institute of India has estimated that in order to make the country self-sufficient pyrethrum cultivation will have to be extended to about 120 000 acres so as to produce annually about 15 000 short tons (2 ooo Ibs a ton) of pyrethrum flowers This estimate makes allowance for a sixth of the total area under cultivation lying fallow each year 34 As an insecticide the relationship of DDT to pyrethrum Is somewhat simular to that of mepacnne to quinide in the treat ment of malanza There is the possibility in both cases of the synthetic substance replacing to a greater or less extent the use of the other It may bowes er be pointed out that the indiscri minate use of DDT has been shown to result in the destruction of certain types of beneficial insects It is quite likely that in ·APPENDICES 107 due course adequate safeguards will be discovered and introduced in order to present these detrimental effects There is also the possibility that wssecticides nore potent than DDT may be produced and brought into use While recogtusing that these possibilities should be guen due weight we think that the cultiva tog of pyrethrun in India should be des eloped us the use of D'OT bas become established Even whes thus stage *s reached the production of a certain amount of pyrethrum will still be gecessary tf as has been suggested a combination of DDT and pyrethrum is more effective than either of them alone Another reason which has prompted us to advocate the continuance of its culavation is that at short notice it can f Decessary be gives up and replaced by other crops Here again the steps required to foster the increased growth of pyrethrum must be decided by Gosemments after a full examination of the relevant factors We can only stress the necessity for a largely increased supply of pyrethram flowers at a reasonable price and the duty of Gover ments na ludia to take immediate steps to ensure production or a scale suficient for the needs of the country 35 Clinical Research wa Malena-wule one line of attack in the malatra problem is through the control of the carrier types of mosquitoes another sbould be directed towards the eluidation of the reservoirs of afection As relapses are quite common in malaria a person who suffers from an attack of the disease con unues in an appreciable percentage of cases to barbour the para site for a varying length of time The complete destruction of all the parasites in such persons should ford an important part of an antimalarial campaign One of the kinitations of all anti malanal drugs so far avaslable (including quiaine mepacrine and plasmoquine) is that they help to kill only such of the parasites * are present in the arculatng blood of the patient while those which are harboured in the spleen and other internal organs escape The achuesements of chemotherapy have danng recept Sears been so brilliant that it is quite conceivable that a drug may be discovered with power to take the parasite sot only to the Circulating blood but also in those internal organs to which it finds refuge Any such drug when discovered and tested in the labo ratory can be considered to be effective only by a reasonably large field Inal on human beings We feel that there is nood for the active promotion of combined biochemical and chnical research alting at the evolution of a suitable drug which will help not only to cure the patient for the time being but also to destroy the para mtes is tam completely 36. We consider the promotion of active research in malana to be of fundamental importance in this country The creation of Chairs of Valanology in selected medical colleges is a bighly desir able step this connection These professorships would scrit a ·108 INTRODUCTION TO MALARIA PROBLEM IN INDIA double purpose namely the fostering of reseatch in malana and the provision of adequate facilities for undergraduate and post graduate training in the subject 37 Legislation–The effective enforcement of antimosquito measures requires suitable legislation and we have given as appurdices 15 16 and 17* respectively the Model Mosquito Ordı nance of the United States Public Health Service the Straits Settle ments Destruction of Mosquitoes Ordinance No 174 and those sections of the Bombay City Municipal Act which deal with anti mosquito measures in order that they may be examined by the different health authonties in the country with a view to seeing how far they may be followed as models CERTAIN SUGGESTIONS BY SIR FREDERICK JAMES OBE MLA FOR INCREASING QUININE PRODUCTION 38 (1) Before deciding on the method of increasing the pro duction of cinchona bark in India it would be well to study the production methods in the Netherlands East Indies which before the War supplied over 90 per cent of the world s quinine Their dominating position has been achieved through a combinaton of Government and private efforts and the systematic way in which the industry has been organised (2) Nine tenths of the cinchona produced in the NE Indies comes from prvate plantations but the improved types of cinchona and the improved methods of cultivation and propaga tion are derived from the work carried out at the Government cnchona plantations Judged by ordinary standards of commer cial accountancy the production of cinchona on prvate estates will always be cheaper than on Government estates If therefore the aim is to produce quinine at as reasonable a cost as possible every attempt should be made to persuade planters to take up its cultivation (3) A Central Cinchona Bureau for India simuar to the kina Bureau of the Netherlands East Indies should be established Such a Bureau might well have two experimental stations one situated in the North and the other situated in the South with plantations attached If such a Bureau were placed under the Impenal Coun al of Agricultural Research and private planters were associated with it India would have taken the first step towards raising cheap cinchona for the only bark which is really cheap is the bark of the high yielding types (4) The main work on both these experimental stations would be the study of plant breeding vegetative propagation cultivation manunng and the regeneration of plantations which had already finished one cycle of cinchona growing Appendices I (b) (c) and (d) ·APPENDICES Іоо (5) One of the reasons why enchona production has been so backward in India is its provincialization in Madras and Bengal the lack of an all India policy and the failure of the Governments concerned either to associate experienced planters with the deve lopment of their stations or to encourage private enterpnse (6) On page 153 there are two general propositions (a) That the prices at which antimalana drugs including quinine are made available to the people should be sufficiently low to enable the poorest classes to obtain them in adequate amounts for the effective treatment of the disease This will involve a certain amount of price control and in the event of private plantations being encouraged profit control also But the planting of cinchona is a nsky enterpnse and if profits are to be controlled in order to ensure that the price of quinine is kept at a reasonably low level then a guaranteed offtake at a fixed price is the only inducement which will encourage pnvate enterprise The world price of cinchona has fluctuated around Rs 20 per lb and the expenence of the Netherlands East Indies has shown that a reasonably profitable industry can be a sound basis for a normal and nstant production This should be recognised by those who wish to see quinine provided at a cheap price for it can only be achieved if economy is effected in the costs of production and distnbution by efficient management or funds are provided from public revenues to meet the loss incurred by inefficient production Costs of production can be reduced by scientific research and efficient organisation and of this industry is well aware (b) That no delay should be allowed to occur in starting new plantations on an adequate scale If a Central Cinchona Bureau ts established it should be fairly simple to plan production with a view both to ensunng supplies of bark to existing factories and where new areas are being opened up for the maintenance of other factones in full production Government stations should also assist by raising plants of good quality for sale to private growers Sales would be partly adjusted to the cinchona which they desired to establish in any areas The cinchona industry should be essentially an all India con cem but at present at 1s provincial and dealt with by two provin cial Governments If the price guarantee is agreed to by the Central Government then it could be made conditional on a cer tain amount of control over policy both of extensions and scientific research. If the Madras and the Bengal Governments are not prepared to asociate the Impenal Council of Agricultural Research with the planning of the work at their stations then the Central Government should establish its own research station in Coorg which is a centrally administered area and is suitable for planta tion of cinchona ·IOS INTRODUCTION TO MALARIA PROBLEN IN INDLA double purpose namely the fastenng of research in malana and the prizon of adequate facilities for undergraduate and post graduate training in the subject 37 Legislation --The effective enforcement of antimosquito measures requires suitable legislation and we have given as appui dico 15 16 and 17* respectively the Vodel Vosquto Ordre nance of the United States Public Health Service the Straits Settlements Destruction of Mosquitoes Orduante lo 174 and those Sections of the Bombay Cats Vunicipal Act which deal with antimosquito measures in order that they may be examined by the different health authonties in the coantry with a view to seeing how far they may be followed as models CERTAN SUGGESTIONS BI SIR FREDERICK JAMES O.B E. VLL FOR INCREASING QUININE PRODUCTION 3S (1) Before dead.ng on the method of mcreasing the production of anchona burk in India it would be well to study the productron methods in the Netherlands East Indies which before the War supplied over oo per cent of the world s quinine Their dominating position has been achieved through a combination of Government and pnsate efforts and the systematic way in which the industri has been organixd (2) Vine-tenths of the anchona produced in the E. Indies comes from prvate plantations bat the improved fpes of anchona and the improved methods of culovation and propagan ton arc denird from the work carried out at the Government cinchona plantations. Judged by ordinary standards of commer cal accountancy the production of anchona on private estates will always be cheaper than on Government states. * it, therefore the am is to produce quiaine at as reasonable a cost as possible every attempt should be made to persuade planters to take tp its cularytion (3) A Central anchona Barcau for India similar to the hinx Bureau of the Ictherlands East Indies should be established Sach a Bureau msht tell have to experimental stations, one situated in the Worth and the Ocher situated in the South mth plantations attached If such a Burau were placed under the Imperial Com a of encultural Research and parate planters were asvaated with it, India would have taken the first step towards rasuak cheap aachana for the only hart which realh cheap as the bark of the hash greld.ng tips (4) The man work on both these experimental stations would be the study of plant breeding trgatve propagation cultivation maaunny and the restauration of plantations, which had alreadr finished one aide of anchoas growing man I () () and 1 ·APPENDICES 109 (5) One of the reasons why cinchona production has been so backward in India is its provincialization in Madras and Bengal the lack of an all India policy and the failure of the Governments concemned either to associate experienced planters with the deve lopment of their stations or to encourage prvate enterprise (6) On page 153 there are two general propositions (a) That the prices at which antimalaria drugs including zuinine are made available to the people should be sufficiently low to enable the poorest classes to obtaia them adequate amounts for the effective treatment of the disease This will involve a certain amount of pnce control and in the event of private plantations being encouraged profit control also But the planting of cinchona is a risky enterpnse and if profits are to be controlled in order to ensure that the price of quinine is kept at a reasonably low level then a guaranteed offtake at a fixed price 13 the only inducement which will encourage private enterprise The world price of cinchona has fluctuated around Rs 20 per lb and the expenence of the Netherlands East Ladies has shown that a reasonably profitable industry can be a sound basis for a normal and constant production This should be recognised by those who wish to see quinine provided at a cheap price for it can only be achieved if economy is effected in the costs of production and distribution by efficient management or funds are provided from public revenues to meet the loss incurred by inefficient pro duction Costs of production can be reduced by scientific research and efficient organisation and of this industry is well aware (b) That no delay should be allowed to occur in starting new plantations on an adequate scale If a Central Cinchona Bureau is established it should be fairly simple to plan production with a view both to ensunng supplies of bark to existing factortes and where new areas are being opened up for the maintenance of other factones in full production Government stations should also assist by raising plants of good quality for sale to prvate growers Sales would be partly adjusted to the cinchona which they desired to establish in any The cinchona industry should be essentially an all India con cem but at present it is provincial and dealt with by two provin aal Governments If the price guarantee is agreed to by the Central Government then it could be made conditional on a cer tain amount of control over policy both of extensions and scientific research If the Madras and the Bengal Governments are not prepared to associate the Imperial Council of Agricultural Research with the planning of the work at their stations then the Central Government should establish its own research station 10 Coorg whuch us a centrally administered area and is smtable for planta tion of cinchona areas ·108 INTRODUCTION TO MALARIA PROBLEM IN INDIA double purpose namely the fostenng of research in malana and the provision of adequate facilities for undergraduate and post graduate training in the subject 37 Legislaton-The effective enforcement of antimosquito measures requires suitable legislation and we have given as app dice I5 16 and 17* respectively the Model Mosquito Orda nance of the United States Public Health Service the Straits Settle ments Destruction of Mosquitoes Ordinance No 174 and those sections of the Bombay City Municipal Act which deal with anto mosquito measures in order that they may be examined by the different health authonties in the country with a view to seeing how far they may be followed as models CERTAIN SUGGESTIONS BY SIR FREDERICK JAMES OBE ML 4 FOR INCREASING QUININE PRODUCTION 38 (1) Before deciding on the method of increasing the production of cinchona bark in India it would be well to study the production methods in the Netherlands East Indies which before the War supplied over 90 per cent of the world s quinine Their dominating position has been achieved through a combination of Government and private efforts and the systematic way in which the industry has been organised (2) Nine tenths of the cinchona produced in the NE Indies comes from private plantations but the improved types of cinchona and the improved methods of cultivation and propaga tion are derived from the work carried out at the Government cinchona plantations Judged by ordinary standards of commer cal accountancy the production of cinchona on pnvate estates will always be cheaper than on Government estatesIf therefore the aim is to produce quinine at as reasonable a cost as possible every attempt should be made to persuade planters to take up its cultivation (3) A Central Cinchona Bureau for India similar to the Kina Bureau of the Netherlands East Indies should be established Such a Bureau might well have two expenmental stations one ituated in the North and the other situated in the South with plantations attached If such a Bureau were placed under the Impenal Coun al of Agncultural Research and pnyate planters were associated with it India would have taken the first step towards raising cheap cinchona for the only bark which is really cheap is the bark of the high yielding types (4) The main work on both these expenmental stations would be the study of plant breeding vegetative propagation cultivation manunng and the regeneration of plantations which had already finished one cycle of cinchona growing Appendices I (b) (c) and (d) ·APPENDICES 109 (3) One of the reasons why cinchona production has been so backward in India is sts provincialization in Madras and Bengal the lack of an all India policy and the failure of the Governments concerned either to associate expenenced planters with the deve lopment of their stations or to encourage prvate enterpnse (6) Os page 153 there are two general propositions (a) That the prices at which adtunalaria drugs including quoine are made available to the people should be sufficiently low to enable the poorest classes to obtain them in adequate amounts for the effective treatment of the disease This will uvolve a certain amount of pnce control and in the event of pavalc plantations being encouraged profit control also But the planting of cunchona is a nsky enterprise and if profits are to be controlled in order to cosure that the pnce of quine is kept at a reasonably low level then a guaranteed offtake at a fixed price 13 the only inducement which will encourage private enterprise The world price of cincbona has fluctuated around Rs 20 per lb and the expenence of the Netherlands East Indies has shown that a reasonably profitable industry can be a sound basis for a normal and caastant production This should be recognised by those who wish to see quinune provided at a cheap pncefor it can only be achieved if economy is effected in the costs of production and distnbution by efficient management or funds are provided from public tevenues to meet the loss mcurred by wefficient producbon Costs of production can be reduced by scientific research and efficient organisation and of this industry is well aware (b) That no delay should be allowed to occur in starting new plantabons on an adequate scale If a Central Cinchona Bureau is established it should be fairly simple to plan production with & view both to ensunog supplies of bark to existing factores and where new areas are being opened up for the maintenance of other factories in full production Govergrent stations should also assist by raising plants of good quality for sale to prvate grouers Sales would be partly adjusted to the anchona which they desired to establish in any ancas The anchona industry should be essentially an all India con cern but at present it is provincial and dealt with by two provin cal Goverments 11 the pnce guarantee is agreed to by the Central Government then it could be made conditional on a cer tain amount of control over policy both of extensions and scientific research If the Madras and the Bengal Governments are sot prepared to associate the Imperial Council of Agricultural Research worth the planaing of the work at the stations then the Central Gorerament should establish its own research station sa Coorg which w a centrally administered area and is sutable for planta tion of cunchona ·APPENDIX I(b) NODEL MOSQUITO ORDINANCE UNITED STATES PUBLIC HEALTA SERVICE Sechon 1 It shall be unlawful for any persos to have keep maintain cause of permit within the corporate Smits of any collection of standing or dowing water in which mosquitoes breed or are likely to breed unless such collection of water as treated so as effectually to prevent such breeding Section 2 Collections of water in which mosquitoes breed or are likely to breed are those contained in ditches ponds pools excavations holes depresions open cess-pools prvy vault fountaias c>terns tanks shallow wells barrels troughs (except borse troughs in frequent use) urns cans boxes bottles tubs buckets defective house roof gutters tanks or flush closets or other water containers Sechon 3 -The natural presence of mosquito larvae in standing or running water shall be evidence that mosquitoes are breeding there Sechon 4 ~Collections of water in which mosquitoes breed or are ukely to breed shall be treated by such one or more of the following methods as shall be approved by the health officer - (Here follows description of methods) Section 5 la case the person responible for the condition of premises on which mo quitoes breed or are kikely to breed fatis os refuses to take necessary measures to prevent their breeding within three days after notice in wnung has been given bum by the health officers or within such longer time after such notice as may be specified in the notice the said person responsible shall be deemed gulty of a violation of this ordinance and for each day after the expiration of three days from the day on wbuch such notice is given him or for each day after the expiration of the time specified in the notice as the case may be that the person responsible fails or refuses to take such measures the sud person responsible shall be deemed gulty of a separate nolation of this ordinance and in case of such farlare or refusal of the person responsible the health officer is authorised to take necessary measures to prevent the breeding of mosquitoes and all necessary costs incurred by the health officer for that purpose shall be a charge agaiast the person responsible Section 6 For the purpose of this ordinance the person resu possible for the condition of any premises is the person using or occupyiog the same or in case no person is assag or occupzzag the premises the person who by law is entitled to the mediate possession of the same or in case the premises are used or ·APPENDICES 113 occupied by two or more tenants of a common landlord each tenant honever is responsible for that part of the premises which he occupes to the exclusion of the oder tenants Provided that in case the prenduses are occupied by a tenant under an yearly or monthly tenancy or under a lease for not more than a year or under any lease whereby the lessor is expressly or implsedly obligated to keep the premises en repair and the collector of standaog or flowing water is whuch mosquitoes breed or are likely to breed is owing to the disrepair of the building or buidings or to any natural quality of the premises or to any conditions that e usted at the time when the tenant entered inta possession or to anything done on the premises by the landlord dunog the existence of the tenancy or lease then and in such case the landlond as the person responsable provided further that any person who has caused to exist on any premises of wbuch be is not the owner Jandlord accupant or tenant any collection of water in which mosquitoes breed or are likely to breed is responsible as well as the owner landlord tenant or occupant as the case may be Section 7 I or the purpose of enforcing the provisions of thus ordinance the bealth officer or bus lawful subordinate may at all Teasonable times enter in and upon any premises within his junsdiction Section & Any person found guilty of a wolation of thus ordinance as described in Section s hereof shall be punished by a fine of not less than one dollar ($ 1) and not more than twenty fite dollats ($ 25) Sechon gThis ordinance shall be in full force and effect on and after the 1 day from the day on which it is approved ·116 INTRODUCTION TO MALARIA PROBLEM IN INDIA (d) to bring any water or swamp into a condition not favourable to the propagation or harbouring E mosquitoes (e) to fill with concrete or otherwise treat hollows in trees which hold or are likely to hold water 7 Enforcement of order (1) If the owner or occupier of any premises on whom an order under section 4 or 5 has been served fails to comply with the terms thereof the sanitary authority or any person authorised by him either generally or specially in that behalf in writing may enter upon or into the said premises with such assistants and things as are necessary and may perform and do thereon or therein all acts and things required by the said order to be performed or done and the cost thereof shall be re coverable from the owner or occupier by the sanitary authonty (2) If the amount of such costs is not paid by the party liable to pay the same within seven days after demand such amount may be reported to a Police Court and overed in the same way as if it was a fine imposed by such Court (3) Nothing in this section shall effect any liability of any person to prosecution and punishment under section 8 8 Penalty for default – (1) Any owner or occuper of any premises on whom an order under sechon 4 or 5 has been served who neglects to comply with the terms thereof shall be liable on conviction by a Police Court to a fine not exceeding fire hundred dollars or to imprisonment of either description for a term wbuch may extend to six months (2) No person shall be punishable under this section for neglect to comply with any order in respect whereof he has appealed as hereinafter provided unless such order has been confirmed on appeal Persons unable to meet necessary expenditure --If it appears to the sanitary authonty after due inquiry that any person has not the means to meet the necessary expenses of doing any thing required to be done by her under this Ordipance such necessary expenses may be met from Municipal or Rural Board Funds as the case may be II No compensation —No person shall be entitled to com pensation for any expense incurred or damage occasioned by any order given or act done in pursuance of this Ordinance or any rule made thereunder unless such damage has been occastoned malt ciously or without reasonable cause 13 Penalty for obstructing sanitary authonty - Any person who obstructs the sanitary authonty or any person authonsed by him or any person engaged in carrying out this Ordinance in any act authorised by this Ordinance shall be liable on convic tion by a Police Court to a fine not exceeding two bundred dollars or to imprisonment of either description for a term shich may extend to three months ΙΟ ·APPENDICES 117 14 Penalty for injuriag works etc executed etc by sant tary authority Any person who without the consent of the sanitary autkonty interferes with injuries destroys or renders useless any works executed or any matenals or thurgs placed is under or upon any premises by or under the orders of the sanatary authonty shall be hable on conviction before a Police Court to a fine not exceeding five hundred dollars and the santary aothonty may n addition recover from such person in the same manger as if it was fine imposed by a Police Court such costs and expenses as it incurs in re executing the works or replacing the materials of things so interfered with injured destroyed or rendered useless 15. Duty of owner and occupier to protect works for destruc on of mosquitoes -- (1) Where the samutary autbonty or any department of Governmeat of the Bunicipahty has constructed any works with the object of preventing the breeding of mosquitoes bether before or after the coming into force of this Ordmance the owner and the occupier of the premises on which such works stand shall prevent such premises beisg used in any manner whatsoever that ss likely to cause or has caused the deterioration or to lessen the efficiency of such works (2) Penalty Where any such premuses are used in such a manner as to lessen the full eficiency of such works the owner and the occupier of such premises shall subject to sub section (4) be kable ou conviction before a Police Court to a fine not exceed ing five hundred dollars and the sanitary authority may enter upon the prerases and execute any necessary tepárrs or work thereon and recover from such person a the same manner as if it was fine imposed by a Police Court such costs and expenses as at thereby ucurs ·APPEYDIY Id) ANIIVOSQUITO PROVISION IN THE BOWBAI MUNICIPAL ACT Section 3 - Definition of terms (1) Water work includes a lake stream spring pump reservoir cisters tank duct whether covered or open sluice mainpipe culvert engine and any machinery land building or thing for supply or used for supplying water (2) Nuisance includes any act omission place or thing which causes or is likely to cause injury danger annoyance or offence to the sense of sight smelling or hearing or which is or may be dangerous to life or injunous to health or property (aa) Dangerous Disease means cholera and any endemic epidemic or infectious disease by which the life of man is endangered Section 61-Matters to be provided for by the Corporation It shall be incumbent on the corporation to make adequate provision by any means of measures which is lawfully competent to them to use or take for each of the following matters namely (d) The reclamation of unhealthy localities the removal of noxious vegetation and generally the abatement of all nuisances (8) Dleasures for preventing and checking the spread of dangerous diseases Section 64 Special functions of the Commissioner -(3) sub ject whenever it is in tlus Act expressly so directed to the approval or sanction of the corporation or the standing committee and subject also to all other restrictions limitations and conditions imposed by this Act the entire executive power for the purpose of carrying out the provisions of this Act vests in the Commissioner Section 68 --Municipal officers may be empowered to exercise certain of the powers of the Commissioner -(1) Any of the powers duties or functions conferred or imposed upon or vested in the Commissioner by any of the sections sub sections or clauses mentioned in sub section (2) may be exercised performed or discharged under the Commissioner s control and subject to his revi sion and to such conditions and limitations of any as he shall think fit to prescribe by any municipal officer whom the Com missioner generally or specially empowers 10 wnting in this behalf and in each of the said sections sub-sections and clauses the word Commissioner shall to the extent to which any muni cipal officer is so empowered be deemed to include such officer (2) The sections sub sections and clauses of this Act referred to in sab-section (1) are the following namely 279 374 377 381 381A 488 489 ·APPENDICES 119 Svakor 274 Provisions as to wstems (1) The Commis 320ner may wherever it shall appear to him to be necessary by written notice requre that any premises furnished wth a private water supply from any municipal water work shall within a reasonable penod which shall be presenbed in the said dotace be provided with a storage cisters of such size material quality and descripton and with such fittings and placed in such a position and with such means of access as he thinks ft Sector 279-Poner to cut off pnvate water supply or to turn of water. (1) The Commissioner may cut off the connection bet Feen any municipal water work and any premises ta which a guvate water supply is furnished by the corporation or turn off the water from such premises in any of the following cases zarurly b) of the owner of Occupier of the presuses neglects within the penod prescnbed in this behalf in any notice given under mb-section (1) of section 274 to comply with any requusitron made to hun by the Commissioner regarding the provision of a storage cisterd or the means of access there to provided that the Commissioner shal not take action without the sanction of the standing comtaittee Section 374 Power to inspect premises for sanitary pur poses - The Commissioner way inspect any building or other premises for the purpose of ascertaing the stary conditions thereof (But sce Section 488) Sechon 377.--Neglected premises II B shall appear to the Commissioner that any premises are overgmwa with rank and Doisomem vegetaton or are otherse un an unwholesome or filthy condition or by reason of their not being properly enclosed are resorted to by the public for purposes of nature or are ot&erwise & Busance to the neighbouring inhabitants the Coraldissioner may by wntten notice require the owner or occuper of such premises to cleanse clear or enclose the same or with the approval of the standing committee may require burn to take such other order with the same as the Commissioner thinks necessary Section 397...Fillag of pools, etc which are a nuisance - in the opinion of the Comessssioner- (5) any pool ditch tank med pound quarrybole drain Watercourse or any collection of water or (0) any cistern receptacle for water or any arucie oz thing capable of cotaning water whetder or agt such cistern or recep tacle article or tung contains water and is within or outside a building or (c) any land og wluch water accumulates of 13 likely to accumulate or { any premises or part of any premises occupied or un Occupied or under constriction reconstruction of demolition : 9 ·120 INTRODUCTION TO MALARIA PROBLEM IN INDIA or is likely to become a breeding place of mosquitoes or which is in other respects a nuisance as defined in clause (z) of section 3 (11) The Commissioner may by notice in writing require the person by whose act default or sufferance a nuisance anses exasts or continues or is lkely to arise and the owner lessee or occupier of the land building or premises on which the nusance anses exists or continues or is likely to anse or any one or more of such person owner lessee and occupier to remove discontinue or abate the awsance by taking such measures and by executing such work in such manner with such materials as the Commissioner shall presenbe in such notice (it) The Commissioner may also by any notice under clause (u) or by another notice served on such person owner lessee and occupier or on any one or more of them require them or any one or more of them to take all steps requisite or necessary to prevent a recurrence of the nuisance and may if he thinks it desirable specify any work to be executed or measures to be camed out for that purpose and may serve any further such notice notwithstanding that the nuisance may have been abated or removed if he considers that it is likely to recur Provided that if at any time within six months from the date of the service of any such notice the nuisance recurs through the failure of the person or persons upon whom such notice has been served to comply with the requirements contained in such notice such person or persons shall be liable without any further notice to the penalties provided in this Act for offences under this section (10) Where the nuisance arises or exists or is likely to anse or recur in connection with the construction reconstruction of demolition of any premises or part of any premises the Com missioner may in addition to serving any notice on any one or more of the persons mentioned in clause (11) serve any such notice on any architect contractor or other persons employed to carry out such work of construction reconstruction or demolition and also on any sub-contractor employed by such contractor or other person or any one or more of such contractor person and sub contractor Section 381 A Permission for new well etc --(1) No new well tank pond astern or fountain shall be dug or constructed without the previous permission in wnting of the Commissioner (2) If any such work is begun or completed without such permission the Commissioner may erther- (a) by wntten notice reqmre the owner or other person who has done such work to fill up or demolish such work in such manner as the Commissioner shall presenbe or (6) grant wnitten permission to retain such work but such permission shall not exempt such owner from proceedings for contravening the provisions of sub-section (1) Section 461 --By laws for what purposes to be made.-The / ·APPENDICES 121 corporation may from time to time make by laws not inconsistent Anth this Act with respect to the following maters namely - () regulating in any particular not specifically provided for In this Act the construction maintenance and control of drains ventilation shafts or Pipes cess-pools water-closets prvies latrines onnals drainage works of every description whether belonging to the corporation or to other persons municipal water works pnvate communication pipes and public streets (6) regulating all matters and things connected with the supply and use of water Section 471 --Certain offences punishable with fine-Whoever (4) contravenes any provision of any of the sections subsections or clauses mentioned in the first column of the following table or of any regulation made thereunder or () fails to comply with any requisition lawfully made upon him under any of the said sections sub-sections or clauses shall be punished for each such offence with fine which may extend to the amount mentioned in that behalf in the third column of the said table Fine which Section sub section or clause Subject may be imposed Rs Section 274 50 Section 377 50 Section 381 Requisition to provide storage other fittings to be used for con nections with water works Requisition to cleanse etc neg lected premises Requisition to fill in pools etc which are a nuisance Digging or constructing well etc without permission Requisition to fill in or demolish well etc 50 Section 381 A subsection (1) Section 381 A subsection (2) 500 500 been convicted of Section 472_Continuing offences Whoever after having (a) contravening any provision of any of the sections sube Sections or clauses mentioned in the first column of the following table or of any regulation made thercunder or (6) failing to comply with any requisition lawfully made apon him under any of the said sections sub-sections or clauses continues to contravene the said provision or to neglect to comply ·INTRODUCTION TO MALARIA PROBLEM IN INDIA (3) If within the period prescnbed in an order made under sub-section (1) the provision is dot camed out or enforced the Governor un Council may appoint some person to carry out of enforce the same and may direct that the expense of carrying out or caforcing such provision together with such reasonable remuneration to the person carrying out or enforcing the same As the Governor in Council stali determine and the cost of the proceedings under this section shall be paid out of the munapal fund ·AD 1 MALARIA BUREAU BULLETES IN THE HEALTH BULLET SERIES No to I Lectures on malina By G Corell 4th edition 19.49 As 5 or 6 1 Syroptc table for the identification of the absopheline mosquilors of India. BY S R Christophers I A Sinton G Corell and P $Batraad 4th edition re med enlarged and illustrated by I 3 Pun 1947 Re 2/6 of 28, 6c 10 3. Agluosquito measures with special reference to India By G Covel rh edition 1945 As 8 or od No 4 Tábl for the identification of Indian fresh water fishes #th descnption of certain families and observations on the relative utíkty of the probable larvivorous fishes of India zad edition revised and enlarged by SL Hora and D D Mukherjee 1938 As 7 of 80 NO S Instructions for collecting and forwarding mosguides By J A Sinton 4th edition revised by 1 X Poz 1940 As 8 orgd do o How to do a malaria survey? By S R Christopher JA Sinton and G Covelisth edition 1944 Rex/ 12 Qr 29 to Synoptic table for the identification of the full grown farve of the Indian anopheline mosquitoes By M Puri 6th Adsbod 1945 Rs 318] OT 55 60 ho The distnbution of anopheline mosquitoes in India By G Covell and edition revised and brought up to date by IP 1935 As 6 or Sd No 9 A practical entomological course for students of mala nology By P J Barraud 4th edition revised by I M Pun 1948 Ře 7/12 of 2s 6d ho za Man made malana in India By J A Sinton and Raja Ram 3rd edition revised by G Covell 1949 no Handbook of coremon water and marsh plants of India and Busena By C C Calder and a BisW35 1937 Prevention of malara incidental to engineering construc bon By HW Bullgan and h Ainds 1938 At 7 or 6 43 23 Wat malana casts ladia? By J A Sinton SOTE These balletins are obtainabis from the Manager of Publications, Goverament of India Ceatral Publication Braach Civil Lines Delhi. RS 2/12 ory AS 34 or 1s 3d ·128 INTRODUCTION TO MALARIA PROBLEM IN INDIA Halophila ovala 21 33 Haplockilus 51 Health Survey and Development Committee Report 84 93 124 Hexaethyl tetraphosphate 64 History I 11 13 29 75 83-85 Holes in rocks trees sands 41 House construction 65 66 67 Hydrants 42 Hydrilla verticillata 32 33 Hygrorhiza anstata 32 lomunity 33 34 Incidence malaria 7 10 30 31 Income per capita 85 Incubation period 14 Infant mortality 10 86 Intermittent drying 42 Ipomæa 32 Irrigation 41 42 Isopentaquine 79 Malang (contd ) bistory III 13 29 75 83-83 unty 33 34 man made 35 36 mosquito 17 25 occupation 35 organisation Provincial 110 parasite 12 t6 plant life 32 33 race 34 sex 35 survey 69 73 treatment 75-82 War 7-9 Man made malaria 35 36 Medical protection 90 91 Mopacrine (atebnn) 78 81 Meteorological factors 31 32 MISH 62 Morbidity 7 10 86 Mortality 7 10 86 Mosquito 17 25 animal barrier 45 carriers of little or do import ance 23 25 identification 17 important carriers 18 21 in neighbounng countries 25 life cycle 17 18 local camers 22 23 measures against 45 61-68 pets 67 68 ongia of the word 3 protection against 65-68 repellents 67 68 Mycrocystis drugenosa 33 Mynophyllum tuberculatum 32 Jungle clearance 43 Jussura repens 32 1 Lagarostpron Roxburghu 32 Lantana 50 Larvae measures against 39-00 Larvivorous fish 51 53 Lebistes reticulatus 51 Legislation 91 112 124 Lemna 37 Lado 41 Love call mosquito trap 65 Lyngbya 21 33 / Najas 20 32 33 Naturalistic control 46-53 Nets 67 68 Macedonia 78 Macropodus 51 Malana age 34 35 69 Bureau Bulletins 125 Climate 31 32 congenital 35 control measure 39-74 cost 9 distnbution 28 31 epidemics 36 37 38 forecast 36 Occupation 3 Octachlor 64 Oiling 53 55 Ordinance 112 114 Organisation 89 90 98 r09 110 III ·129 INDEX Oscillatona 20 21 33 Oupbrancmus SI Paludnde (Proguanil) 80 81 Pamaqain (Plasmoquine) 78 79 Panckat St Parasite 3 6 11 16 Pasathron 64 Paru grech 55 57 Pentaquine 79 Personnel protection 65-68 Pipeless siphon 48 49 Pipes 42 Pustia strat otes 24 32 33 Plant hfe and Malaria 32 33 Plasmodium falciparum 12 16 32 Anou lost 17 80 malana 12 16 32 ovala 12 forma 12 vivax 12 16 32 Plasmoquino (Pamaquin) 78 79 Pollution 50 st Pools 42 Potamogenton pictinatus 21 33 Pratyan ha ? Prevalence 28 31 Prxes 86 Proguasil (Paludrine) 80 81 Provincial Headquarters equipment Salt content 51 Salt mia cucullata 33 Schusothorax progastus SI Seepages 39 Sewage 43 Sex 35 Sult 41 48 Supbon 46 49 Sluicing 46 49 Spirogyra 22 Spleen rate 69 Statistics 7 10 15 16 Sub-drainage 10 Subsidiary drain 39 Subsoil drauage 40 Suggestions 88-92 93 124 Sulpbonam des 80 Suppressive treatment 81 82 Surface drain 39 Survey 69-73 Susruta 1 2 3 Swamps 39 Swimming pools 42 Synergist 64 65 Takman Tanks 42 Tetraethyl pyrophosphato 64 Top mianow 51 Totaquina 77 Toxaphede 64 Treatment 75-82 Tachogaster fasciatus 51 orgeoisa taon Utnculans 20 32 33 Trovincial Malaria 110 Puntius 51 Pyrethrum 61 62 Vall suena spiral s 32 Ventilation sbart 43 Vertical drain 40 Quarties 41 Qalaine 4 5 75 78 Helis 42 Wolffia 32 Race 34 Railwayt 43 Relapses 14 16 30 79 81 Repellents 67 68 Residual spraying 63 Roads 43 Zoograptucal position 19

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